Timing of Vascular Endothelial Growth Factor Inhibitor Reinitiation and Risk of Wound Complications in Spinal Metastasis Surgery.

BACKGROUND: Vascular endothelial growth factor inhibitors (VEGFi) are widely used for metastatic cancer management but are known to impair wound-healing. In spinal metastasis surgery, postoperative wound complications remain a clinical challenge, and the perioperative management of systemic antineoplastic therapies remains poorly defined. Current recommendations regarding postoperative VEGFi reinitiation are largely consensus-based and range from 28 to 40 days. The aims of this study were to evaluate the association between perioperative antineoplastic therapies and wound complications and to define the optimal timing of postoperative VEGFi reinitiation.

METHODS: This retrospective cohort study included 1,164 Taiwanese patients (684 male and 480 female; median age, 60.7 years [interquartile range, 51.5 to 68.8 years]) who underwent spinal metastasis surgery at a single tertiary center between 2010 and 2022. The outcome was postoperative wound complications within 90 days. Multivariable logistic regression was used to identify independent risk factors. The association between the timing of postoperative VEGFi reinitiation and wound complications was assessed using receiver operating characteristic curve analysis and the Fisher exact test.

RESULTS: Wound complications occurred in 301 patients (25.9%). Multivariable analysis identified diabetes mellitus (odds ratio [OR] = 4.58; p < 0.001), poor performance status (Eastern Cooperative Oncology Group score ≥2; OR = 3.07; p = 0.002), perioperative use of VEGFi (OR = 4.12; p < 0.001), and perioperative use of antimetabolites (OR = 2.24; p = 0.04) as independent risk factors. Patients reinitiating VEGFi within 40 days had higher complication rates than both nonusers and those reinitiating VEGFi after 40 days, with the former comparison reaching statistical significance.

CONCLUSIONS: One-quarter of the patients undergoing spinal metastasis surgery experienced postoperative wound complications. Perioperative use of VEGFi was an independent predictor, and our results suggest that there should be a postoperative cessation interval of 40 days to reduce wound-related risk. Clinicians should balance the oncologic benefits of early VEGFi reinitiation against the heightened risk of complications.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.