Xiao-Miao Zhang1, Ludovic Fournel2, Audrey Lupo3, Emelyne Canny2, Antonio Bobbio2, Salomé Lasry2, Jean-François Regnard2, Frederic Sailhan4, Marco Alifano5. 1. Department of Thoracic Surgery, Paris-Center University-Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France; Department of Thoracic Surgery, Shanghai General Hospital affiliate to Shanghai Jiao Tong University, Shanghai, China. 2. Department of Thoracic Surgery, Paris-Center University-Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France. 3. Department of Pathology, Paris-Center University-Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France. 4. Department of Orthopedic Surgery, Paris-Center University-Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France. 5. Department of Thoracic Surgery, Paris-Center University-Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France. Electronic address: marco.alifano@aphp.fr.
Abstract
BACKGROUND: Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive operation remains controversial. The aim of this study was to characterize a single-center cohort and to evaluate the outcome, focusing on survival and complications. METHODS: We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncologic and functional analysis. RESULTS: There were 31 patients operated on. An induction therapy was administered in 20 patients. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in 48.3% of the patients, and osteosynthesis was required in 22 patients. We observed no in-hospital death and a major complications rate of 32.3%, including 5 patients with early neurologic complications. There were 61.3% primary lung carcinomas, 12.9% extrapulmonary primaries, 9.7% metastases, and 16.1% benign tumors. Mean follow-up was 32.1 months. The 5-year overall survival rate was 81.3% in the entire cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall survival (p = 0.03). The 5-year disease-free survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients, including persistent neurologic deficit in 12.9%, instrumentation migration in 19.4%, and local infection in 12.9%. CONCLUSIONS: En bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical or infectious complications.
BACKGROUND: Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive operation remains controversial. The aim of this study was to characterize a single-center cohort and to evaluate the outcome, focusing on survival and complications. METHODS: We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncologic and functional analysis. RESULTS: There were 31 patients operated on. An induction therapy was administered in 20 patients. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in 48.3% of the patients, and osteosynthesis was required in 22 patients. We observed no in-hospital death and a major complications rate of 32.3%, including 5 patients with early neurologic complications. There were 61.3% primary lung carcinomas, 12.9% extrapulmonary primaries, 9.7% metastases, and 16.1% benign tumors. Mean follow-up was 32.1 months. The 5-year overall survival rate was 81.3% in the entire cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall survival (p = 0.03). The 5-year disease-free survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients, including persistent neurologic deficit in 12.9%, instrumentation migration in 19.4%, and local infection in 12.9%. CONCLUSIONS: En bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical or infectious complications.
Authors: Nathan J Pertsch; Owen P Leary; Joaquin Q Camara-Quintana; David D Liu; Tianyi Niu; Albert S Woo; Thomas T Ng; Adetokunbo A Oyelese; Jared S Fridley; Ziya L Gokaslan Journal: J Neurosurg Case Lessons Date: 2021-02-08