PRIMARY EN-BLOC RESECTION IN THE TREATMENT OF PRIMARY TUMOURS WITH LOCAL INVASION OF THE SPINE

Abstract

Purpose: Report results of patients undergoing en-bloc resection of thoracic tumours with local invasion of the spinal column

Methods: Retrospective chart and outcome review

Results: The mean age was 59.1 (range 26–75) years. Patients underwent pre-operative radiation±chemotherapy. Anterior and posterior approaches were performed in all cases, staged a mean 16.2 days apart (range 4–51 days) in nine patients. There were eight non-small cell lung carcinoma, and four sarcomas. The mean total operative time was 12.8 hours(range 9–15). All patients survived the operative procedures and were discharged home. Mean hospital stay was 30.3 days(range 11–97). Positive tumour margins were present in 2 patients. Complications include need for revision thoracotomy, prolonged post-op intubation, one case of fatal PE, one superficial wound infection. Two patients died at four months post-operatively, (2/2 negative tumour margins) and one at 13 months(positive margin). Four patients were disease-free at > 1 year (range 13–40 months). The remaining patients have less than 1 yr f/u with 4/5 disease-free. Oswestry scores are 54.5 at latest f/u compared to 11.3 pre-op(p=0.007). SF-36 PCS and MCS were 35.5 and 51.1 pre-op compared to 25.6(p=0.3) and 38.3(p=0.03) post-op.

Conclusions: En-bloc resections offer curative resections at the expense of worse ODI and SF-36 scores. Staged surgeries allowed for an easier technical resection during the second stage.