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Lu M, Zhou Z, Chen W, Lei Z, Dai S, Hou C, Du S, Jin Q, Jin D, Boriani S, Li H. En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the “rotation–reversion” technique: Feasibility, safety, and clinical outcome of 11 cases. Front Oncol 2022; 12:1031708. [DOI: 10.3389/fonc.2022.1031708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundEn bloc resection of spinal tumors provides better local control and survival outcomes than intralesional resection. Safe margins during en bloc resection of primary spinal tumors with epidural involvement are required for improved outcomes. The present study describes a “rotation–reversion” technique that has been used for en bloc resection of huge primary tumors in the mobile spine with epidural involvement and reported the clinical outcomes in these patients.MethodsAll patients with primary spinal tumors who were treated with the rotation–reversion technique at our institution between 2015 and 2021 were evaluated retrospectively. Of the patients identified, those with both huge extraosseous soft-tissue masses and epidural involvement were selected for a case review. Clinical and radiological characteristics, pathologic findings, operative procedures, complications, and oncological and functional outcomes of these patients were reviewed.ResultsOf the 86 patients identified with primary spinal tumors who underwent en bloc resection using the rotation–reversion technique between 2015 and 2021, 11 had huge extraosseous soft-tissue masses with epidural involvement in the mobile spine. The average maximum size of these 11 tumors was 8.1 × 7.5 × 9.7 cm. Median follow-up time was 28.1 months, mean operation time was 849.1 min (range 465–1,340 min), and mean blood loss was 6,972.7 ml (range 2,500–17,700 ml), with 10 (91%) of the 11 patients experiencing perioperative complications. The negative margin rate was 91%, with only one patient (9%) experiencing local recurrence. Ten patients were able to walk normally or with a crutch at the last follow-up, whereas one was completely paralyzed preoperatively.ConclusionThe rotation–reversion technique is an effective procedure for the en bloc resection of huge primary spinal tumors, with the extension of invasion in selected patients including not only the vertebral body but also the pedicle and part of the posterior arch.
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Dandurand C, Fisher CG, Rhines LD, Boriani S, Charest-Morin R, Gasbarrini A, Luzzati A, Reynolds JJ, Wei F, Gokaslan ZL, Bettegowda C, Sciubba DM, Lazary A, Kawahara N, Clarke MJ, Rampersaud YR, Disch AC, Chou D, Shin JH, Hornicek FJ, Laufer II, Sahgal A, Dea N. Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study. Neurosurg Focus 2021; 50:E16. [PMID: 33932923 DOI: 10.3171/2021.2.focus201091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Oncological resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, the execution of a meticulously drafted plan sometimes fails. The objectives of this study were to determine how successful surgical teams are at achieving planned surgical margins and how successful surgeons are in intraoperatively assessing tumor margins. The secondary objective was to identify factors associated with successful execution of planned resection. METHODS The Primary Tumor Research and Outcomes Network (PTRON) is a multicenter international prospective registry for the management of primary tumors of the spine. Using this registry, the authors compared 1) the planned surgical margin and 2) the intraoperative assessment of the margin by the surgeon with the postoperative assessment of the margin by the pathologist. Univariate analysis was used to assess whether factors such as histology, size, location, previous radiotherapy, and revision surgery were associated with successful execution of the planned margins. RESULTS Three hundred patients were included. The surgical plan was successfully achieved in 224 (74.7%) patients. The surgeon correctly assessed the intraoperative margins, as reported in the final assessment by the pathologist, in 239 (79.7%) patients. On univariate analysis, no factor had a statistically significant influence on successful achievement of planned margins. CONCLUSIONS In high-volume cancer centers around the world, planned surgical margins can be achieved in approximately 75% of cases. The morbidity of the proposed intervention must be balanced with the expected success rate in order to optimize patient management and surgical decision-making.
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Affiliation(s)
- Charlotte Dandurand
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Raphaële Charest-Morin
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Feng Wei
- 6Peking University Third Hospital, Beijing, China
| | | | | | - Daniel M Sciubba
- 8Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aron Lazary
- 9National Center for Spinal Disorders, Budapest, Hungary
| | | | | | | | | | - Dean Chou
- 14University of California, San Francisco, California
| | - John H Shin
- 15Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - IIya Laufer
- 17Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Arjun Sahgal
- 18Sunnybrook Hospital, University of Toronto, Ontario, Canada
| | - Nicolas Dea
- 1Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
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