**Minimal Invasive Surgery of Metastatic Bone Tumor**

Hyun Guy Kang and San Ha Kang

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64341

#### **Abstract**

[14] Dunne RF, Hezel AF. Genetics and Biology of Pancreatic Ductal Adenocarcinoma.

[15] Eyol E, Murtaga A, Zhivkova-Galunska M, Georges R, Zepp M, Djandji D, et al. Few genes are associated with the capability of pancreatic ductal adenocarcinoma cells to

[16] Al-Taee KK, Ansari S, Hielscher T, Berger MR, Adwan H. Metastasis-related processes show various degrees of activation in different stages of pancreatic cancer rat liver

[17] Kwon JJ, Nabinger SC, Vega Z, Sahu SS, Alluri RK, Abdul-Sater Z, et al. Pathophysio‐ logical role of microRNA-29 in pancreatic cancer stroma. Sci Rep 2015;5:11450.

Hematol Oncol Clin North Am. 2015;29(4):595–608.

126 Tumor Metastasis

grow in the liver of nude rats. Oncol Rep. 2012;28(6):2177–2187.

metastasis. Oncology research and treatment. 2014;37(9):464–470.

Bone is one of the most common metastatic areas in the cancer patient. Bone metastasis is the major cause to deteriorate the quality of life due to severe pain, walking difficulty, paraplegia, and pathologic fracture. To maintain patient's general condition and continue scheduled medical treatment, various minimally invasive surgical methods have been developed. The percutaneous methods including alcohol or bone cement (polymethyl methacrylate [PMMA]) injection, laser or radiofrequency ablation, cryosurgery, and MRI-HIFU have shown favorable outcomes in the spine, pelvis, and other flat bones. Using only these percutaneous methods have high risk of pathologic fracture in the long bone of extremity, which needs some metallic fixation. Therefore, the new surgical method and instrument involving percutaneous internal fixation with PMMA bone cement injec‐ tion have been introduced. The PMMA bone cement injection is effective in the metastat‐ ic bone tumor, providing reliable mechanical augmentation of destructive bone, durable local tumor suppression, and effective pain relief. The hollow-perforated screw and nail (multihole injection screw and nail) has central canal and multiple side holes to facilitate injection of bone cement to the bone lesion. An optimal customized surgical option according to the patient's circumstances should be planned.

**Keywords:** metastatic bone tumor, minimal invasive surgery, hollow-perforated screw, percutaneous fixation and injection, palliative management
