The role of intralesional margin en bloc resection in malignant and local aggressive spinal neoplasms

English Keywords:Vertebrae  Neoplasm  En bloc resection  Piecemeal resection  Surgical margin

English Abstract:

  【Abstract】 Objectives: To observe the spinal tumor local control and survival rate and its complications in patients with malignant and invasive tumor and undergoing intralesional margin en bloc resection. Methods: 47 patients with primary or solitary metastatic spinal tumors receiving intralesional margin en bloc resection were included in this study. The patients were divided into two groups according to en bloc or piecemeal resections. There were 32 patients and 15 patients in two groups, respectively. Factors included age, gender, tumor malignancy, involved spinal levels, surgical approaches, receiving total spondylectomy or not, follow-up time, blood loss volume, operation time, tumor local recurrence, survive, and complications were compared between two groups. Results: The difference was not significant(P＞0.05) between two groups with regard to age, gender, tumor malignancy, involved spinal levels, surgical approaches, receiving total spondylectomy or not, improvement of postoperative neurological function or follow-up time. Patients with en bloc resection had longer average operation time(424.53±236.93min vs 306.67±90.92min) and more blood loss volume(4043.75±2305.80ml vs 3680.00±3163.23ml) than patients with piecemeal resection(P＜0.05). Complications were noted in 11 patients(34.4%) and 3 patients(20%) in group of en bloc resection and group of piecemeal resection, respectively. In group of en bloc resection, 12 patients (37.5%) had local recurrence, 17 patients survived with no evidence of disease, 8 patients lived with disease, and 7 patients died of disease at the end of follow-up. In group of piecemeal resection, local recurrence occurred in 9 patients (60%), and 5 patients survived with no evidence of disease, 5 were alive with disease, and 5 died of disease, respectively. The differences on local recurrence free survival rate and overall survival rate between two groups were significant(P<0.05). Conclusions: En bloc resection for patients with malignant or invasive spinal tumors has better local tumor control, higher survival rate and complication rate than patients with piecemeal resection, even with intralesional margin.