P17.23.B SINGLE INSTITUTION RETROSPECTIVE ANALYSIS OF COMPLICATIONS ASSOCIATED WITH SURGICAL DEBULKING OF BRAIN METASTASIS: SINGLE VS MULTIPLE LESIONS

Abstract

BACKGROUND Surgical resection of brain metastasis is associated with complications, which worsens patient’s quality of life, resulting in oncological treatment delays and death. Surgical complication data aids decision making, leads to objective risk benefit analysis and informed consent. The aim of this study is to quantify the impact of the number of intracranial metastases on the rate and types of post-operative complications. MATERIAL AND METHODS Retrospective analysis on adult patients with brain metastasis, who underwent surgical debulking between 2017 and 2023 at Royal Preston Hospital. Data collected included demographics, primary tumour, number of lesions, 30-days post-operative complications, 30-days post-operative mortality and palliation, Karnofsky-Performance Score (KPS), and first vs. repeat resection. Univariate analysis carried out using R studio software. RESULTS Our patient cohort (n=226), 80 (35.6%) experienced post-operative complications. Top-five most common complications were Hospital-acquired pneumonia (HAP) (n=30, 13.3%), surgical site infection (SSI) (n=23, 10.2%), wound dehiscence (n=11, 4.9%), thromboembolic events (n=14,6.2%) and CSF leak (n=8, 3.5%). Average length of admission was 19.9 days (1-120) for patients with complications compared to 6.9 days (2-31) for patients without complications. Thirty (37.5%) patients with complications were readmitted. One-hundred twenty-seven patients (56.1%) had solitary lesion and 99 patients (43.9%) had multiple lesions. The most common primaries for patients with solitary lesion were lung (n=51, 40.2%), breast (n=25, 19.7%), and gastrointestinal (n=21, 16.5%). Whereas the most common primaries for multiple metastases were lung (n=41, 41.4%), breast (n=18, 18.2%), and skin (n=18, 18.2%). Amongst patients with complications, 45 (45.5%) had multiple metastases whilst 35 (27.6%) had solitary. The most common complications for patients with solitary lesion were HAP (n=10, 7.9%), SSI (n=9, 7.1%) and thromboembolism (n=8, 6.3%). Common complications for multiple lesions were HAP (n=20, 20.2%), SSI (n=14, 14.1%) and wound complications (n=10,10.1%). Patients with multiple metastases had higher 30-days post-operative palliation [(n=12) 12.1% vs (n=0) 0% solitary) and higher 30-days mortality [(n=4) 4% vs (n=4) 3.1% solitary). Multiple metastases were statistically significant for complications (p=0.005), HAP (p=0.006) and 30-days palliation (n=0.0001) but not statistically significant for SSI, 30-days mortality or thromboembolism. Conclusion: Surgical debulking is associated with significant post-operative complications, especially patients with multiple metastases with 16% either dying or not receiving any further treatment. Furthermore, 14.1% develop serious complications requiring further surgical interventions whilst 34.3% requires medical treatment.