World Neurosurg. 2020 Jan 23. pii: S1878-8750(20)30111-X. doi: 10.1016/j.wneu.2020.01.093. [Epub ahead of print]
Perioperative complications and prognosis of curative surgical resection for spinal metastases in elderly patients.
Yonezawa N1, Murakami H2, Demura S3, Kato S3, Yoshioka K4, Shinmura K3, Yokogawa N3, Shimizu T3, Oku N3, Kitagawa R3, Handa M3, Annen R3, Kurokawa Y3, Tsuchiya H3.
Author information
KEYWORDS:
complication; corpectomy; elderly patients; hemivertebrectomy; spinal metastasis; spondylectomy; survival analysis
PMID: 31982597 DOI: 10.1016/j.wneu.2020.01.093
Similar articles
Select item 203498732.
Orthopedics. 2010 Mar;33(3). doi: 10.3928/01477447-20100129-10. Epub 2010 Mar 10.
Perioperative complications and prognosis for elderly patients with spinal metastases treated by surgical strategy.
Murakami H1, Kawahara N, Demura S, Kato S, Yoshioka K, Sasagawa T, Tomita K.
Author information
Abstract
The rapidly aging population and improved long-term survival due to advancement of cancer treatment have expanded the role of surgical treatment in elderly patients with metastatic spinal disease. The purpose of this study was to evaluate in elderly patients the perioperative complications and prognosis for metastatic spinal disease. Thirty-two elderly patients (>70 years) who underwent surgical treatment based on Tomita's surgical strategy for spinal metastasis since 1999 were retrospectively reviewed. Mean survival time of 15 patients with 2 to 4 points in surgical strategy was 23.6 months; of 10 patients with 5 to 7 points was 15.2 months; and of 7 patients with 8 to 10 points was 5.2 months. In 5 elderly patients (15.6%), the appropriate surgical choice based on the surgical strategy was not possible due to their preoperative conditions. Perioperative complications encountered were respiratory in 6 patients (18.8%), cardiovascular in 3 (9.4%), and delirium in 4 (12.5%). In the nonelderly 161 patients, respiratory complications occurred in 4 patients (2.5%), cardiovascular in 1 (0.6%), and delirium in 2 (1.2%). Respiratory complications and delirium occurred at a significantly higher frequency in the elderly group. Even for elderly patients, the postoperative prognosis could be predicted by the surgical strategy. However, the optimal surgical procedure may deviate from that predicted by the surgical strategy due to their preoperative conditions and an increased risk for perioperative complications. Despite the increased potential for complications, more radical procedures, such as total en bloc spondylectomy, should not be avoided solely due to advanced patient age.
Copyright 2010, SLACK Incorporated.
PMID: 20349873 DOI: 10.3928/01477447-20100129-10
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 228810383.
J Neurosurg Spine. 2012 Oct;17(4):271-9. doi: 10.3171/2012.7.SPINE111086. Epub 2012 Aug 10.
Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine.
Fang T1, Dong J, Zhou X, McGuire RA Jr, Li X.
Author information
Abstract
OBJECT:
The object of this study was to compare the mini-open anterior corpectomy procedure with posterior total en bloc spondylectomy (TES) in treating patients with solitary metastases of the thoracolumbar spine.
METHODS:
From 2004 to 2010, 41 patients with solitary metastases of the thoracolumbar spine were treated in our hospital using either a mini-open anterior corpectomy or posterior TES. Intraoperative and diagnostic data, including perioperative complications, were collected using retrospective chart review. The surgical outcomes were assessed according to survival status, neurological function, local recurrence, and pain before and after surgery.
RESULTS:
Seventeen patients underwent posterior TES and 24 underwent mini-open anterior corpectomy. Mean blood loss (TES, 1721 ± 293 ml; mini-open corpectomy, 1058 ± 263 ml; p < 0.05), and mean operative time (TES, 403 ± 55 minutes; mini-open corpectomy, 175 ± 38 minutes; p < 0.05) were recorded and calculated. Neurological improvement by at least 1 American Spinal Injury Association Impairment Scale grade was noted in 35 (97.2%) of the 36 cases with preoperative deficits. After the operation, 68.4% of nonambulatory patients became ambulatory again, including 84.6% after mini-open corpectomy and 33.3% after posterior TES (p > 0.05). The visual analog scale scores of the patients were significantly reduced after both procedures, with no difference between the procedures (p > 0.05). The local tumor recurrence rate of the TES group was significantly lower than that of the mini-open corpectomy group (p < 0.05), while the postoperative survival rates within 2 years after surgery were similar. The complication rate in the mini-open corpectomy group (29.2%) was higher than that in the TES group (11.8%), but this difference was not statistically significant (p = 0.185). There was no hardware failure and no loss of the sagittal Cobb angle in either group. Slight subsidence (< 3 mm) of the mesh cage was observed with a successful fusion in 3 (17.6%) of 17 patients in the TES group. No subsidence of polymethylmethacrylate block/autograft was recorded in the mini-open group.
CONCLUSIONS:
Mini-open anterior corpectomy can be accomplished with less blood loss, fewer fixation instrumentations, and shorter surgical time than that required for TES, but patients who undergo a mini-open corpectomy might have a greater tendency to experience local recurrence. A mini-open anterior corpectomy has a relatively mild learning curve and involves fewer technical difficulties. With smaller incisions, mini-open anterior corpectomy is an option in treating solitary metastases of the thoracolumbar spine.
Comment in
Spine metastasis. [J Neurosurg Spine. 2012]
PMID: 22881038 DOI: 10.3171/2012.7.SPINE111086
[Indexed for MEDLINE]
Similar articles
Publication types, MeSH terms
Select item 208871374.
J Neurosurg Spine. 2010 Oct;13(4):414-7. doi: 10.3171/2010.4.SPINE09365.
Total en bloc spondylectomy for lung cancer metastasis to the spine.
Murakami H1, Kawahara N, Demura S, Kato S, Yoshioka K, Tomita K.
Author information
Abstract
OBJECT:
The prognosis in patients with a distant spinal metastasis from the lung is dismal. The role of radical surgery in such cases has been questioned because of the excessive morbidity, blood loss, and operative time as well as the tumor's extreme malignancy. The purpose of this study was to evaluate the surgical results and the prognosis associated with radical surgery for lung cancer metastasis to the spine in carefully selected patients and to clarify whether there is an indication for radical surgery such as total en bloc spondylectomy (TES) in lung cancer metastasis.
METHODS:
The author performed a retrospective review of patients with lung cancer spinal metastasis treated by TES during a 10-year period. Total en bloc spondylectomy for lung cancer metastasis to the spine was performed in 6 patients without visceral or other bony metastases. Outcome measures were prognostic score, mean survival time, and perioperative complications. The histological type was adenocarcinoma in all 6 cases. In 4 cases the surgical strategy prognostic score was 5. In the other 2 cases the score was 6 because there were skip metastases to adjacent vertebra. In the 2 cases with adjacent vertebral metastasis, the adjacent vertebra was excised en bloc together.
RESULTS:
The mean estimated blood loss was 1076 ml and the mean operative time was 7 hours 20 minutes. Perioperative complications were found in 2 cases. One was deep infection after CSF leakage, and the other was paralysis due to postoperative hematoma. At the end of follow-up period, 4 of 6 patients are still living after a mean of 46.3 months (range 36–62 months). In the other 2 cases, 1 patient died of a heart attack and the other of mediastinitis due to surgical site infection by methicillin-resistant Staphylococcus aureus. In this series, local recurrence was not found.
CONCLUSIONS:
Total en bloc spondylectomy has been shown to be associated with excessive morbidity, blood loss, and operative time; however, the procedure is becoming less invasive. The authors conclude that TES is appropriate in selected cases with controllable primary lung cancer, localized spinal metastasis, and no visceral metastasis. In such patients, improvement in the prognosis can be expected after TES. However, even in selected cases and with skilled surgical technique, the complication rate remains high. Total en bloc spondylectomy should be performed after a thorough discussion of the risks and benefits.
Comment in
En bloc resection for metastatic spinal tumors: is it worth it? [J Neurosurg Spine. 2010]
PMID: 20887137 DOI: 10.3171/2010.4.SPINE09365
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 211846435.
J Neurosurg Spine. 2011 Feb;14(2):172-6. doi: 10.3171/2010.9.SPINE09878. Epub 2010 Dec 24.
Total en bloc spondylectomy for spinal metastases in thyroid carcinoma.
Demura S1, Kawahara N, Murakami H, Abdel-Wanis ME, Kato S, Yoshioka K, Tomita K, Tsuchiya H.
Author information
Abstract
OBJECT:
Thyroid carcinoma generally has a favorable prognosis, and patients rarely present with distant metastases. Authors of several studies have proposed piecemeal resection for spinal metastases in thyroid carcinoma; however, few have analyzed the impact of local curative surgery such as total en bloc spondylectomy (TES) for thyroid carcinoma. The purposes of the present study are to determine the strategy of surgical treatment for spinal metastases of thyroid carcinoma and to evaluate the surgical results of and the prognosis associated with TES.
METHODS:
Twenty-four cases of spinal metastases were retrospectively reviewed. The patients included 16 women and 8 men, with a mean age of 60.7 years. Histological examination showed follicular carcinoma in 15 cases, papillary carcinoma in 8, and medullary carcinoma in 1. Total en bloc spondylectomy was performed in 10 cases; debulking surgery, such as piecemeal excision or eggshell curettage, was performed in 14. The average follow-up time was 55 months (12-180 months).
RESULTS:
Four patients had no evidence of disease, 8 were alive with the disease, and 12 had died of the disease. The overall survival rate from the time of surgery was 74% at 5 years. Patients with visceral metastases had a significant, higher risk of death. The survival rate of patients following TES was 90% at 5 years, which was higher than the rate in patients who underwent debulking surgery (63%). However, no significant difference was observed between the 2 types of surgery. There was a local recurrence after debulking surgery in 8 (57%) of 14 cases. Because of the recurrences, reoperation was required after a mean of 41 months. In contrast, there was a local recurrence after TES in only 1 (10%) of 10 cases. The difference between debulking surgery and TES regarding local recurrence was statistically significant.
CONCLUSIONS:
Total en bloc spondylectomy with enough of a margin provided favorable local control of spinal metastases of thyroid carcinoma during a patient's lifetime.
PMID: 21184643 DOI: 10.3171/2010.9.SPINE09878
[Indexed for MEDLINE]
Similar articles
MeSH terms
Select item 180853446.
J Gastrointest Surg. 2008 Jun;12(6):1054-60. Epub 2007 Dec 18.
Perioperative morbidity affects long-term survival in patients following liver resection for colorectal metastases.
Schiesser M1, Chen JW, Maddern GJ, Padbury RT.
Author information
Abstract
BACKGROUND:
Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases.
METHODS:
One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction, and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an objective surgical complication classification.
RESULTS:
The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%. The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative complications was 3.2 years, compared to 4.4 years in those patients without complications (p < 0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients with a margin (p = 0.019).
CONCLUSION:
Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following liver resection for colorectal metastases.
Comment in
Peri-operative morbidity affects the long-term survival in patients following liver resection for colorectal metastases. [J Gastrointest Surg. 2009]
PMID: 18085344 DOI: 10.1007/s11605-007-0438-y
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 259325997.
J Neurosurg Spine. 2015 Aug;23(2):217-27. doi: 10.3171/2014.12.SPINE14543. Epub 2015 May 1.
Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach.
Lau D1, Chou D1.
Author information
Abstract
OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade), number of corpectomies performed, and number of levels instrumented. The open group had a mean operative time of 413.6 minutes, and the mini-open group had a mean operative time of 452.4 minutes (p = 0.329). Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs. 1697.3 ml, p = 0.019) and a significantly shorter hospital stay (7.4 days vs. 11.4 days, p = 0.001). There was a trend toward a lower perioperative complication rate in the mini-open group (9.5%) compared with the open group (21.4%), but this was not statistically significant (p = 0.265). At follow-up, there were no significant differences in ASIA grade (p = 0.342), complication rate after the 30-day postoperative period (p = 0.999), or need for surgical revision (p = 0.803). The open approach had a higher overall infection rate of 17.9% compared with that in the mini-open approach of 9.5%, but this was not statistically significant (p = 0.409). CONCLUSIONS The mini-open transpedicular corpectomy is associated with less blood loss and shorter hospital stay compared with open transpedicular corpectomy. The mini-open corpectomy also trended toward lower infection and complication rates, but these did not reach statistical significance.
KEYWORDS:
AP = anterior-posterior; ASIA = American Spinal Injury Association; EBL = estimated blood loss; MIS = minimally invasive surgery; PE = pulmonary embolus; corpectomy; expandable cage; metastatic spine tumor; mini-open; minimally invasive; oncology; pRBCs = packed red blood cells; thoracic; transpedicular
PMID: 25932599 DOI: 10.3171/2014.12.SPINE14543
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 90518958.
Spine (Phila Pa 1976). 1997 Feb 1;22(3):324-33.
Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors.
Tomita K1, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y.
Author information
Abstract
STUDY DESIGN:
The study of seven patients with primary malignant or benign aggressive tumors who underwent a new aggressive surgical technique termed "total en bloc spondylectomy" is reported.
OBJECTIVES:
To report a new surgical technique of total en bloc spondylectomy for complete, resection of primary spinal malignancy and for oncologic curability.
SUMMARY OF BACKGROUND DATA:
The conventional approach for primary spinal malignancy is via intralesional piecemeal resection, and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.
METHODS:
Total en bloc spondylectomy, consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation, was performed in five patients with primary malignant tumors and two patients with giant cell tumors. Patients were observed for 2 years to 6.5 years, except for one patient who died 7 months after surgery because of a mediastinal metastasis.
RESULTS:
All patients, except one, attained significant clinical improvement after surgery with no major complications. Histologically, the margins were wide or marginal except for the pedicles, and occasionally the spinal canal and the posterior, where they were accepted to be intralesional. One patient died of metastasis that was not directly related to surgery itself. There was no local recurrence.
CONCLUSIONS:
The advantages of total en bloc spondylectomy include resection of the involved vertebra(e) in two major blocs, rather than in a piecemeal pattern, and completion of the procedure during one surgical session posteriorly. The "total en bloc spondylectomy" offers one of the most aggressive modes of therapy for primary spinal malignancy.
PMID: 9051895 DOI: 10.1097/00007632-199702010-00018
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 314406199.
Spine Surg Relat Res. 2017 Dec 20;1(2):96-99. doi: 10.22603/ssrr.1.2016-0020. eCollection 2017.
Radical surgery consisting of en bloc corpectomy in recurrence after palliative surgery for spinal metastasis.
Sugita S1, Murakami H1, Yonezawa N1, Demura S1, Tanaka S2, Tsuchiya H1.
Author information
Abstract
INTRODUCTION:
We often experience recurrence of spinal metastases after palliative surgery, even with radiotherapy. We examined the clinical outcome of radical surgery containing en bloc corpectomy for patients with recurrent spinal metastasis.
METHODS:
Seven patients underwent en bloc corpectomy for recurrent spinal metastases. We assessed the prognosis scores (Tomita, Tokuhashi), pre- and postoperative Frankel scale scores, operation time, intraoperative blood loss, and perioperative complications.
RESULTS:
The preoperative estimated prognosis was less than six months (two patients), six months to one year (two patients), and over one year (three patients), according to Tokuhashi score. Major perioperative complications were dura mater injury and pleural injury. Neurological improvement was seen in four patients. All patients were ambulatory at discharge and lived longer than the preoperatively estimated life expectancy (range: seven months to four years).
CONCLUSIONS:
Radical surgery consisting of en bloc corpectomy may be a therapeutic choice for patients with recurrent spinal metastases.
KEYWORDS:
en bloc corpectomy; recurrent tumor; spinal metastasis; surgery
PMID: 31440619 PMCID: PMC6698556 DOI: 10.22603/ssrr.1.2016-0020
Free PMC Article
Similar articles
Conflict of interest statement
Select item 3164190710.
Eur Spine J. 2019 Oct 22. doi: 10.1007/s00586-019-06179-8. [Epub ahead of print]
Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches.
Spiessberger A1, Arvind V2, Gruter B3, Cho SK2.
Author information
Abstract
OBJECTIVE:
To compare surgical outcomes between seven different approaches for thoracolumbar corpectomy/spondylectomy in the setting of spinal metastasis.
METHODS:
A systematic review of literature was performed including articles on corpectomy for thoracolumbar spinal metastasis. Data were extracted and sorted by surgical approach: en bloc spondylectomy (group 1), transpedicular (group 2), costotransversectomy (group 3), mini-open retropleural/retroperitoneal (group 4a), lateral extracavitary approach (group 4b), open transthoracic/transretroperitoneal (group 5), and thoracoscopic (group 6). Comparison of demographics, blood loss, directly procedure related complications, operating time, and postoperative improvement of pain.
RESULTS:
A total of 63 articles were included comprising data of 774 patients with various primary tumor entities. Mean age was 51.8 years, 54% of patients were female, on average 1.46 levels were treated per patient, and mean follow-up was 1.59 years. The following statistically significant findings were observed: Blood loss was lowest for the mini-open retropleural/retroperitoneal (917 ml), thoracoscopic (1107 ml) and transthoracic approach (1172 ml) versus the posterior approach groups (1633-2261 ml); directly procedure related complications were lowest for mini-open retropleural/retroperitoneal and thoracoscopic approach (0% each) versus 7-15% in the other groups; operating time was lowest in mini-open retropleural/retroperitoneal approach (184 min) versus 300-588 min in the other groups.
CONCLUSION:
Less invasive approaches (mini-open retropleural/retroperitoneal and thoracoscopic) not only had superior outcome in terms of blood loss and operating time, but also were shown to be safe techniques in cancer patients with low rates of procedure-related complications. These slides can be retrieved under Electronic Supplementary Material.
KEYWORDS:
Anterior decompression; Corpectomy; Mini-open; Spinal metastasis; Spondylectomy
PMID: 31641907 DOI: 10.1007/s00586-019-06179-8
Similar articles
Publication type
Select item 2843637811.
Ortop Traumatol Rehabil. 2017 Jan 26;19(1):23-32. doi: 10.5604/15093492.1235275.
Outcomes of Corpectomy in Patients with Metastatic Cancer.
Guzik G1.
Author information
Abstract
BACKGROUND:
The objective of surgical management of spinal metastases is to reduce pain and improve the patient's quality of life. The operation should restore spinal stability and decompress neural structures. One surgical technique is corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The procedure may be performed in patients in overall good health and a good survival prognosis. The aim of this paper is to present the outcomes of surgical management of spinal metastases in patients who underwent corpectomy followed by vertebral body reconstruction and stabilisation of the spine.
MATERIAL AND METHODS:
The aim of the study was achieved by analysing medical histories of 124 patients with spinal metastases treated in the Oncological Orthopaedics Department in Brzozów in the period 2010-2015. The majority of patients in the group were women, who represented 64% of all the subjects. The average age was 63 years for women and 67 for men. The metastases were most frequently produced by breast cancer (36%) and myeloma (22%). A total of 87% of the group were diagnosed with pathologic fractures and 92% had spinal instability. Stenosis of the spinal canal was found in 78% of the patients. The surgeries were performed in 18 persons with metastases to the cervical spine, 69 patients with metastases to the thoracic spine and 37 participants with metastases to the lumbar spine. Single-level corpectomies were performed in 83 patients and multilevel corpectomies in 41 persons. Parameters analysed comprised overall health condition, neurological function (the Frankel Grade) and performance status (the Karnofsky score) of the patients. A VAS was used to assess the intensity of pain. The course of the operation and complications were also analysed.
RESULTS:
Following the surgeries, the average VAS pain score decreased from 7.2 to 3.8. Performance improved from a Karnofsky score of 50.26 to 68.65. Neurological function improved in 21 out of 34 patients with pareses. The average duration of the surgery was 67 minutes for the cervical spine, 123 minutes for the thoracic spine and 112 minutes for the lumbar spine. The loss of blood was strongest for lumbar spine surgeries, amounting on average to 580 ml. 62% of patients required transfusion ofblood substitutes after the operation. The average hospitalisation time was 14 days, with a minimum and maximum duration of 7 and 24 days, respectively. The most common complication was damage to the endplate of the vertebra adjacent to the prosthesis (11%). Two patients developed complete and irreversible paralysis of lower limbs.
CONCLUSIONS:
1. Corpectomy followed by vertebral body reconstruction should be used in patients with a good prognosis. 2. Therapeutic outcomes are good. The surgery produced a considerable reduction in pain and improvement in performance in the majority of patients. 3. Complications are not frequent. The most common complication is intrusion of the implant into the endplate of the adjacent vertebrae. 4. A high survival rate at one year after the surgery, exceeding 90% of the patients, is evidence of effectiveness of the treatment and appropriate qualification of patients for the operation.
PMID: 28436378 DOI: 10.5604/15093492.1235275
[Indexed for MEDLINE]
Similar articles
MeSH terms
Select item 2971557712.
Clin Neurol Neurosurg. 2018 Jul;170:20-26. doi: 10.1016/j.clineuro.2018.04.007. Epub 2018 Apr 3.
Are older patients with solitary spinal metastases fit for total en-bloc surgery?
Liu P1, Jiang L1, Liang Y1, Wang H1, Zhou H1, Li X1, Lin H1, Zhou X1, Dong J2.
Author information
Abstract
OBJECTIVE:
Due to radical resection, total en-bloc spondylectomy (TES) is associated with significant levels of surgical injury and spinal instability, particularly in elderly patients with solitary spinal metastases (SM), whether the possible benefits outweigh the risk requires intense consideration. Our aim was to compare and analyze the impact of age on patient prognosis.
PATIENTS AND METHODS:
This study investigated TES in 78 consecutive patients with solitary SM, who were divided into Group A (>65 years, n = 32) and group B (<60 years of age, n = 46). Surgical outcomes were assessed according to survival time, local recurrence, neurological function, pain, and quality of life before and after surgery. Differences between groups were statistically compared using analysis of variance (ANOVA) or chi-square tests.
RESULTS:
There was no significant difference between the two groups in terms of surgery duration, blood loss, blood transfusion or the duration of hospital stay (p > 0.05). Furthermore, there was no significant difference in the median survival time between the two groups (p > 0.05). However, the perioperative complication rate in group A was higher than that in group B (p < 0.05). There was no significant difference in terms of local recurrence rate when compared between group A and group B (p > 0.05), and there were no significant differences in terms of improvements in neurological function, Visual Analogue Scale and Karnofsky scores of patients between the two groups (p > 0.05).
CONCLUSION:
Older patients can experience survival and local recurrence rates that were similar to those of younger patients. Although older patients are at increased risk of perioperative complications, this factor does not appear to lead to serious adverse outcomes. Older patients are still good candidates to receive TES to cure solitary SM after careful preparation and strict selection.
Copyright © 2018 Elsevier B.V. All rights reserved.
KEYWORDS:
En-bloc spondylectomy; Kaplan-Meier; Older patients; Spinal metastases; Survival analysis
PMID: 29715577 DOI: 10.1016/j.clineuro.2018.04.007
[Indexed for MEDLINE]
Similar articles
MeSH terms
Select item 1647792113.
Clin Oncol (R Coll Radiol). 2006 Feb;18(1):60-6.
Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer.
Miki C1, Hiro J, Ojima E, Inoue Y, Mohri Y, Kusunoki M.
Author information
Abstract
AIMS:
It is still debated whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise affects the prognosis after curative resection of malignant tumours. We conducted a prospective observational study of patients with colorectal cancer to provide data on the effect of blood transfusion and the related perioperative cytokine response on long-term prognosis.
MATERIALS AND METHODS:
Perioperative blood samples were obtained from 117 patients with colorectal cancer undergoing potentially curative resection. Factors associated with perioperative blood transfusion were assessed, and their relationship with early postoperative systemic responses of tumour growth factors and long-term prognosis were evaluated.
RESULTS:
Independent factors associated with perioperative blood transfusion were preoperative anaemia, operative blood loss and the development of postoperative infectious complication. The patients receiving transfusions were subdivided according to the independent factors. Group A comprised 19 patients who received blood transfusions because of preoperative anaemia and Group B comprised 16 patients who received blood transfusions because of excessive operative blood loss. Group B patients showed exaggerated postoperative systemic induction of interleukin (IL)-6 and IL-6-triggered tumour growth factors, such as hepatocyte growth factor and vascular cell adhesion molecule-1. Intraoperative blood transfusion under intense surgical stress was associated with poor prognosis, whereas preoperative blood transfusion for correcting anaemia or intraoperative blood transfusion under less invasive surgery was not associated with survival. Multivariate analysis using the Cox proportional hazards method showed that a significant independent risk was demonstrated for blood transfusion, T stage, lymph-node metastasis and perioperative peak levels of IL-6.
CONCLUSION:
Blood transfusion and intense surgical stress might synergistically affect the long-term prognosis after curative resection of colorectal cancer. Postoperative exaggerated systemic inductions of IL-6 may indicate the critical situation that could lead to disease recurrence.
PMID: 16477921 DOI: 10.1016/j.clon.2005.08.004
[Indexed for MEDLINE]
Similar articles
MeSH terms, Substance
Select item 2181859814.
Eur Spine J. 2012 Jan;21(1):1-9. doi: 10.1007/s00586-011-1859-6. Epub 2011 Aug 5.
Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases.
Druschel C1, Disch AC, Melcher I, Engelhardt T, Luzzati A, Haas NP, Schaser KD.
Author information
Abstract
INTRODUCTION:
The descriptions of total spondylectomy and further development of the technique for the treatment of vertebral sarcomas offered for the first time the opportunity to achieve oncologically sufficient resection margins, thereby improving local tumor control and overall survival. Today, single level en bloc spondylectomies are routinely performed and discussed in the literature while only few data are available for multi-level resections. However, due to the topographic vicinity of the spinal cord and large vessels, the multisegmental resections are technically demanding, represent major surgery and only few case reports are available. Surgical options are even more limited in cases of revision surgery and local recurrences when en bloc spondylectomy was considered to be not feasible due to high risk of vital complications in expanding resection margins. Deranged anatomy, implants in situ and extensive intra-/paraspinal scar tissue formation resulting from previously performed approaches and/or radiation are considered the principal complicating factors that usually hold back spine surgeons to perform revision for resection leaving the patient to palliative treatment.
METHODS:
We present two patient cases with previously performed piecemeal vertebrectomy in the thoracic spine due to a solitary high-grade spinal sarcoma. After extensive re-staging, both patients underwent a multi (4)-level en bloc spondylectomy in our department (one patient with combined en bloc lung resection). Except a local wound disturbance, there was no severe intra- or postoperative complication.
RESULTS:
After multilevel en bloc spondylectomy both patients showed a good functional outcome without neurological deficits, except those resulting from oncologically scheduled resection of thoracic nerve roots. After a median follow-up of 13 months, there was no local recurrence or distant metastasis. The reconstruction using a posterior screw rod system that is interconnected to an anterior vertebral body replacement with a carbon composite cage showed no implant failure or loosening. In summary, the approach of a multilevel en bloc surgery for revision and oncologically sufficient resection in cases of spinal sarcoma recurrences seems possible. However, interdisciplinary decision making in a tumor board, realistic evaluation of surgical resectability to attain tumor free margins, advanced experiences in spinal reconstructions and involvement of vascular, visceral and thoracic surgical expertise are essential preconditions for acceptable oncological and functional outcome.
Comment in
Expert's comment concerning Grand Rounds case entitled "Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases" (by Claudia Druschel; Alexander C. Disch; Ingo Melcher; Tilmann Engelhardt; Alessandro Luzzati; Norbert P. Haas; Klaus-Dieter Schaser). [Eur Spine J. 2012]
PMID: 21818598 PMCID: PMC3252440 DOI: 10.1007/s00586-011-1859-6
[Indexed for MEDLINE] Free PMC Article
Similar articles
Publication types, MeSH terms
Select item 1584963815.
Z Orthop Ihre Grenzgeb. 2005 Mar-Apr;143(2):186-94.
[Surgical treatment and prognosis factors in spinal metastases of breast cancer].
[Article in German]
Ulmar B1, Richter M, Cakir B, Brunner A, Puhl W, Huch K.
Author information
Abstract
AIM:
The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer.
METHODS:
55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected.
RESULTS:
Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243).
CONCLUSION:
Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.
PMID: 15849638 DOI: 10.1055/s-2005-836512
[Indexed for MEDLINE]
Similar articles
Publication type, MeSH terms
Select item 3048197816.
Asian Spine J. 2019 Apr;13(2):296-304. doi: 10.31616/asj.2018.0145. Epub 2018 Nov 29.
En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery.
Ohashi M1, Hirano T1, Watanabe K1, Hasegawa K2, Ito T3, Katsumi K4, Shoji H1, Mizouchi T1, Takahashi I1, Homma T2, Endo N1.
Author information
Abstract
STUDY DESIGN:
Retrospective case series.
PURPOSE:
To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up.
OVERVIEW OF LITERATURE:
Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking.
METHODS:
We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40-77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan-Meier method, and groups were compared using the log-rank method.
RESULTS:
The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71-39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes.
CONCLUSIONS:
Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.
KEYWORDS:
Margins of excision; Neoplasm metastasis; Recurrence; Spine; Survival
PMID: 30481978 PMCID: PMC6454284 DOI: 10.31616/asj.2018.0145
Free PMC Article
Similar articles
Select item 1898183517.
Neurosurgery. 2008 Oct;63(4 Suppl 2):303-8; discussion 308. doi: 10.1227/01.NEU.0000327569.03654.96.
Biomechanical consequences of cervical spondylectomy versus corpectomy.
Doğan S1, Baek S, Sonntag VK, Crawford NR.
Author information
Abstract
OBJECTIVE:
To evaluate the differences in spinal stability and stabilizing potential of instrumentation after cervical corpectomy and spondylectomy.
METHODS:
Seven human cadaveric specimens were tested: 1) intact; 2) after grafted C5 corpectomy and anterior C4-C6 plate; 3) after adding posterior C4-C6 screws/rods; 4) after extending posteriorly to C3-C7; 5) after grafted C5 spondylectomy, anterior C4-C6 plate, and posterior C4-C6 screws/rods; and 6) after extending posteriorly to C3-C7. Pure moments induced flexion, extension, lateral bending, and axial rotation; angular motion was recorded optically.
RESULTS:
After corpectomy, anterior plating alone reduced the angular range of motion to a mean of 30% of normal, whereas added posterior short- or long-segment hardware reduced range of motion significantly more (P < 0.003), to less than 5% of normal. Constructs with posterior rods spanning C3-C7 were stiffer than constructs with posterior rods spanning C4-C6 during flexion, extension, and lateral bending (P < 0.05), but not during axial rotation (P > 0.07). Combined anterior and C4-C6 posterior fixation exhibited greater stiffness after corpectomy than after spondylectomy during lateral bending (P = 0.019) and axial rotation (P = 0.001). Combined anterior and C3-C7 posterior fixation exhibited greater stiffness after corpectomy than after spondylectomy during extension (P = 0.030) and axial rotation (P = 0.0001).
CONCLUSION:
Circumferential fixation provides more stability than anterior instrumentation alone after cervical corpectomy. After corpectomy or spondylectomy, long circumferential instrumentation provides better stability than short circumferential fixation except during axial rotation. Circumferential fixation more effectively prevents axial rotation after corpectomy than after spondylectomy.
PMID: 18981835 DOI: 10.1227/01.NEU.0000327569.03654.96
[Indexed for MEDLINE]
Similar articles
Publication types, MeSH terms
Select item 2703331118.
Spine J. 2016 Aug;16(8):951-61. doi: 10.1016/j.spinee.2016.03.043. Epub 2016 Mar 24.
Are allogeneic blood transfusions associated with decreased survival after surgical treatment for spinal metastases?
Paulino Pereira NR1, Beks RB2, Janssen SJ2, Harris MB3, Hornicek FJ2, Ferrone ML3, Schwab JH2.
Author information
Abstract
BACKGROUND CONTEXT:
Perioperative allogeneic blood transfusions have been associated with decreased survival after surgical resection of primary and metastatic cancer. Studies investigating this association for patients undergoing resection of bone metastases are scarce and controversial.
PURPOSE:
We assessed (1) whether exposure to perioperative allogeneic blood transfusions was associated with decreased survival after surgery for spinal metastases and (2) if there was a dose-response relationship per unit of blood transfused. Additionally, we explored the risk factors associated with survival after surgery for spinal metastases.
STUDY DESIGN/SETTING:
This is a retrospective cohort study from two university medical centers.
PATIENT SAMPLE:
There were 649 patients who had operative treatment for metastatic disease of the spine between 2002 and 2014. Patients with lymphoma or multiple myeloma were also included. We excluded patients with a revision procedure, kyphoplasty, vertebroplasty, and radiosurgery alone.
OUTCOME MEASURES:
The outcome measure was survival after surgery. The date of death was obtained from the Social Security Death Index and medical charts.
METHODS:
Blood transfusions within 7 days before and 7 days after surgery were considered perioperative. A multivariate Cox proportional hazard model was used to assess the relationship between allogeneic blood transfusion as exposure versus non-exposure, and subsequently as continuous value; we accounted for clinical, laboratory, and treatment factors.
RESULTS:
Four hundred fifty-three (70%) patients received perioperative blood transfusions, and the median number of units transfused was 3 (interquartile range: 2-6). Exposure to perioperative blood transfusion was not associated with decreased survival after accounting for all explanatory variables (hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 0.80-1.31; p=.841). Neither did we find a dose-response relationship (HR: 1.01; 95% CI: 0.98-1.04; p=.420). Other factors associated with worse survival were older age, more severe comorbidity status, lower preoperativehemoglobin level, higher white blood cell count, higher calcium level, primary tumor type, previous systemic therapy, poor performance status, presence of lung, liver, or brain metastasis, and surgical approach.
CONCLUSIONS:
Perioperative allogeneic blood transfusions were not associated with decreased survival after surgery for spinal metastases. More liberal transfusion policies might be warranted for patients undergoing surgery for spinal metastasis, although careful consideration is needed as other complications may occur.
Copyright © 2016 Elsevier Inc. All rights reserved.
KEYWORDS:
Allogeneic blood transfusion; Bone metastases; Mortality; Spinal metastases; Spine; Survival
PMID: 27033311 DOI: 10.1016/j.spinee.2016.03.043
[Indexed for MEDLINE]
Similar articles
MeSH terms
Select item 2483875919.
Clin Orthop Relat Res. 2015 Mar;473(3):858-67. doi: 10.1007/s11999-014-3578-x.
Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is challenging but rewarding.
Luzzati AD1, Shah S, Gagliano F, Perrucchini G, Scotto G, Alloisio M.
Author information
Abstract
BACKGROUND:
Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms.
QUESTIONS/PURPOSES:
Using data from a large spine tumor center, we answered the following questions: (1) Does multilevel total en bloc spondylectomy result in acceptable function, survival rates, and local control in spinal neoplasms? (2) Is reconstruction after this procedure feasible? (3) What complications are associated with this procedure? (4) is it possible to achieve adequate surgical margins with this procedure?
METHODS:
We retrospectively investigated 38 patients undergoing multilevel total en bloc spondylectomy by a single surgeon (AL) from 1994 to 2011. Indications for this procedure were primary spinal sarcomas, solitary metastases, and aggressive primary benign tumors involving multiple segments of the thoracic or lumbar spine. Patients had to be medically fit and have no visceral metastases. Analysis was by chart and radiographic review. Margin quality was classified into intralesional, marginal, and wide. Radiographs, MR images, and CT scans were studied for local recurrence. Graft healing and instrumentation failures at subsequent followup were assessed. Complications were divided into major or minor and further classified as intraoperative and early and late postoperative. We evaluated the oncologic status using cumulative disease-specific and metastases-free survival analysis. Minimum followup was 24 months (mean, 39 months; range, 24-124 months).
RESULTS:
Of the 38 patients, 34 (89%) were alive and walking without support at final followup. Thirty-one (81%) had no evidence of disease. Two patients died postoperatively and another two died of systemic disease (without local recurrence). Only three patients (8%) had a local recurrence. There were 14 major complications and 22 minor complications in 25 patients (65%). Only one patient required revision of implants secondary to mechanical failure. Two cases of cage subsidence were noted but had no clinical significance. Wide margins were achieved in nine patients (23%), marginal in 25 (66%), and intralesional in four (11%).
CONCLUSIONS:
In patients with multisegmental spinal tumors, oncologic resections were achieved by multilevel en bloc spondylectomy and led to an acceptable survival rate with reasonable local control. Multilevel en bloc surgery was associated with a high complication rate; however, most patients recovered from their complications. Although the surgical procedure is challenging, our encouraging mid-term results clearly favor and validate this technique.
LEVEL OF EVIDENCE:
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
PMID: 24838759 PMCID: PMC4317411 DOI: 10.1007/s11999-014-3578-x
[Indexed for MEDLINE] Free PMC Article
Similar articles
MeSH terms
Select item 3140469520.
World Neurosurg. 2019 Nov;131:e468-e473. doi: 10.1016/j.wneu.2019.07.206. Epub 2019 Aug 9.
Laminectomy Versus Corpectomy for Spinal Metastatic Disease-Complications, Costs, and Quality Outcomes.
Azad TD1, Varshneya K1, Ho AL1, Veeravagu A1, Sciubba DM2, Ratliff JK3.
Author information
Abstract
BACKGROUND:
The landmark Patchell trial established surgical decompression followed by adjuvant radiotherapy as standard-of-care for patients with spinal cord compression caused by metastatic cancer. However, little comparative evidence exists with regard to the choice of specific surgical approaches for these patients. We sought to conduct a comparative analysis of outcomes of surgical options for spinal metastatic disease.
METHODS:
This was an epidemiologic study using national administrative data from the MarketScan database. We queried the MarketScan database (2007-2016), identifying patients with a diagnosis of spinal metastasis treated with surgical decompression (N = 1054). We used descriptive statistics and hypothesis testing to compare baseline characteristics, complications, quality metrics, and costs.
RESULTS:
We identified patients with spinal metastases undergoing laminectomy (N = 760), corpectomy (N = 193), or both combined procedures (laminectomy and corpectomy, N = 101). No significant differences in baseline demographics, follow-up time, or primary tumor histology were observed. We found a greater 30-day postoperative complication rate among patients undergoing corpectomy (P < 0.0001), driven by increased rate of postoperative anemia and pulmonary complications. Length of stay and 30-day readmission rates did not vary between surgical approaches. Total index hospitalization and 30-day payments were greatest among patients undergoing combined procedures and lowest for patients undergoing laminectomy alone.
CONCLUSIONS:
Our findings highlight distinct complication profiles and quality outcomes associated with selection of surgical approach for patients with spinal metastases. These findings must be interpreted with a clear understanding of the limitations.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Corpectomy; Epidural spinal cord compression; Laminectomy; Spine metastasis
PMID: 31404695 DOI: 10.1016/j.wneu.2019.07.206
Similar articles
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου