Perioperative complications and risk factors of en bloc resection for thoracic and lumbar spinal tumors

English Keywords:Spinal tumor  Thoracic and lumbar spine  En bloc resection  Anterior column reconstruction  Complication

English Abstract:

  【Abstract】 Objectives: To investigate the incidence and risk factors of perioperative complications after en bloc resection for thoracic and lumbar spinal tumors. Methods: The data of patients with thoracic and lumbar spinal tumors treated in our department with en bloc resection and anterior column reconstruction were retrospectively analyzed. Between May 2016 and October 2022, 90 consecutive patients underwent en bloc resection on the basis of Weinstein-Boriani-Biagini surgical staging system, and anterior reconstruction was performed using 3D-printed artificial vertebral bodies. The demographic, oncological, and operative data of the patients were collected prospectively, and the intraoperative and postoperative complications occurring within three months were categorized into major and minor complications according to their impacts on the recovery process(Major complications were considered as any complication that appeared to substantially alter an otherwise full and expected course of recovery, and other complications were regarded as minor). All the patients were divided into the primary group(n=67) and revision group(n=23) based on their previous surgical history. Differences between the two groups in terms of age, gender, pathological type, tumor-involved segments, operative time, intraoperative blood loss, and perioperative complications were compared. The predictive factors for major and minor complications were explored. Results: En bloc resection was achieved in all the patients, including total en bloc spondylectomy in 77 cases, sagittal resection in 12 cases, and vertebrectomy in one case. The mean operative time was 553.4min(210-1208min), and the mean intraoperative blood loss was 1534.1mL(260-5500mL). A total of 129 complications were observed in 65(72.2%) patients, including 29 major complications in 21(23.3%) patients. Two patients(2.2%) died as a result of complications. The revision group was more than primary group in tumor-involved segments(P=0.000) and incidence rate of major complications(P=0.038). In univariate regression analysis, the combined approach[odds ratio(OR)=14.778, P=0.001], total blood loss(OR=1.004, P=0.004), staged surgery(OR=5.250, P=0.008), previous surgical history(OR=2.946, P=0.043), number of tumor-involved vertebrae(OR=1.607, P=0.023) and lumbar tumor(OR=3.509, P=0.015) were statistically significant risk factors for major complication occurrence, while the combined approach(OR=6.375, P=0.036) was the independent risk factor. Conclusions: En bloc resection and anterior column reconstruction is associated with high risks of complications, especially when a combined approach is needed.