Postoperative survival in patients undergoing surgery for long bone metastases: a systematic review and Meta-analysis of outcomes across primary tumor types

Background Surgery for long bone metastases is performed to alleviate pain, restore function, and improve quality of life. Accurate postoperative survival estimates are essential for surgical planning and shared decision-making, yet no comprehensive synthesis exists across primary tumor types. This systematic review aimed to characterize postoperative survival and its temporal trend in patients undergoing surgery for long bone metastases. Methods A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library. Studies reporting survival following surgery for long bone metastases were eligible. Pooled survival estimates were computed using restricted maximum likelihood random-effects meta-analysis. Secular trend analysis used weighted linear regression with study sample size as weights. Risk of bias was assessed at the study level using the Joanna Briggs Institute (JBI) critical appraisal tools, with separate checklists applied for cohort studies and case series. Results A total of 155 studies comprising 27,133 patients were included (1973–2024). Pooled 1-year survival was 47.9% (95% CI 44.1–51.7%, 95% prediction interval 17.7–79.7%, I 2 = 89%; n = 101 studies), declining to 30.8% at 2 years and 16.9% at 5 years. Median survival was 8.0 months (IQR 6.0–11.0 months). Considerable variation was observed by tumor type: thyroid carcinoma and myeloma demonstrated the highest 1-year survival (90.0% and 70.6%, respectively), followed by breast cancer (56.4%), while lung cancer (22.7%), hepatocellular carcinoma (23.2%), and prostate cancer (26.5%) had the lowest. In the contemporary cohort (recruitment end ≥2016; n = 62 studies), pooled 1-year survival was 52.2% (95% CI 47.9–56.4%) and median survival was 10.0 months (IQR 7.0–13.6 months). A statistically significant positive secular trend was identified (+0.47% per year; 95% CI +0.11 to +0.82%; p = 0.012). Conclusions Postoperative survival varies considerably by primary tumor type and has improved significantly over the past decade. These findings, although non-definitive and descriptive, provide contemporary long-bone metastatic disease specific survival benchmarks to inform prognostic counselling.