En bloc resections in the spine - the experience of 220 cases over 25 years.

En bloc resections in the spine - the experience of 220 cases over 25 years.

World Neurosurg. 2016 Oct 26;:

Authors: Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R

Abstract
BACKGROUND AND OBJECTIVES: En bloc resections aim at surgically removing a tumor in a single, intact piece. Approach must be planned for the complete removal of the tumor without violation of its margins. The shared knowledge of the morbidity, mortality, risk assessment for local disease recurrence, complications and death, related to spine tumors excised en bloc could improve the treating physician's apprehension of the diseases and decision making process before, during and after surgical treatment. The purpose of this study was to review and report the experience gained in one of the worlds biggest spine oncological centers of over 25 years.
METHODS: A retrospective study of prospective collected data of 1,681 patients affected by spine tumors, of whom 220 enbloc resections was performed.
RESULTS: Most tumors were primary - 165 cases (43 benign and 122 malignant), metastases occurred in 55 cases. 61 patients died from the disease. 153 complications were observed in 100 patients. 33 local recurrences were recorded. A total of 61 patients died from the disease. A total of 153 complications were observed in 100 out of 216 patients (46.2%). 64 of these patients (30%) suffered one complication, while the rest had 2 or more. All complications were categorized according to temporal distribution and severity. These were further divided into 7 groups according to the type of complication. There were 105 major and 48 minor complications. seven patients (4.6%) died as a result of complications. 33 local recurrences (15.28%) were recorded, Contaminated cases, surgical margins of the resected tumor - intralesional, marginal, and malignant tumors, were statistically significant independent risk factors for local recurrence of the tumor. Contamination, local recurrence, neo-adjuvant RT, the number of level resected, and metastatic tumors compared to primary malignant tumor, were shown to be independent risk factors for patient's death.
CONCLUSION: Treatment of spinal aggressive benign and malignant bone tumors through en bloc resections is beneficial, in terms of better local control and prognosis, although it is a highly demanding and risky procedure. Margins are the key point of this procedure, thus, a careful preoperative oncological and surgical staging is necessary to define the optimal surgical approach. The adverse event profile of these surgeries is high; therefore, it should be performed by experienced and multidisciplinary teams in specialized high volume centers.

PMID: 27794510 [PubMed - as supplied by publisher]

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