En Bloc Surgery in the Thoracic Spine: Indications, Results, and Complications in a Series of Eighty-Five Patients Affected by Primary and Secondary Malignant Bone Tumors

Alessandro Luzzati; Carmela Pizzigallo; Isabella Sperduti; Alessandra Scotto di Uccio; Simone Mazzoli; Luca Cannavò; Gennaro Scotto; Carmine Zoccali

doi:10.1016/j.wneu.2024.02.032

En Bloc Surgery in the Thoracic Spine: Indications, Results, and Complications in a Series of Eighty-Five Patients Affected by Primary and Secondary Malignant Bone Tumors

World Neurosurg. 2024 Feb 16:S1878-8750(24)00228-6. doi: 10.1016/j.wneu.2024.02.032. Online ahead of print.

Authors

Alessandro Luzzati¹, Carmela Pizzigallo², Isabella Sperduti³, Alessandra Scotto di Uccio⁴, Simone Mazzoli¹, Luca Cannavò¹, Gennaro Scotto¹, Carmine Zoccali⁵

Affiliations

¹ Oncological and Reconstructive Surgery Unit, IRCCS-Galeazzi Orthopedic Institute, Milan, Italy.
² Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science, Sapienza University of Rome, Rome, Italy.
³ Statistical Department, IRCCS -Regina Elena National Cancer Institute, Rome, Italy.
⁴ General Surgery and Organ Transplantation Unit, School of General Surgery, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy. Electronic address: allascotto@gmail.com.
⁵ Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science, Sapienza University of Rome, Rome, Italy; Oncological Orthopedics Department, IRCCS -Regina Elena National Cancer Institute, Rome, Italy.

PMID: 38367855
DOI: 10.1016/j.wneu.2024.02.032

Abstract

Background: En bloc resection remains the cornerstone treatment for malignant bone tumors affecting the spine. The thoracic spine poses unique challenges because of the proximity of crucial structures. This study assesses outcomes of patients who underwent en bloc spondylectomy for malignant bone tumors at the thoracic level.

Methods: We retrospectively reviewed 85 cases of primary and secondary bone tumors in the thoracic spine, undergoing en bloc spondylectomy from 1996 to 2016. Evaluation encompassed clinical presentation, tumor characteristics, surgical outcomes, complications, survival, and recurrence.

Results: Of 85 patients, 40 presented directly, whereas 45 had undergone previous intralesional surgery. Chondrosarcoma and chordoma comprised the most prevalent primary histologic types; thyroid and kidney carcinomas were the most frequent secondary tumors. Pain was reported in 75 patients at diagnosis. Margins were adequate in 54 cases and intralesional in 31. Immediate postoperative deaths amounted to 4. Major complications included substantial blood loss, neurologic deterioration, and paraplegia. The 5-year local recurrence-free survival was 58.7%, significantly influenced by the surgical margin: patients with wide margins experienced a 5-year local recurrence-free survival of 85.7%, whereas those with marginal and intralesional margins had rates of 56.7% and 45.6%, respectively; overall recurrence was 22.3%, with no notable disparities between previously treated and untreated patients. The 5-year overall survival was 63.2% and 56.2% for primary and secondary tumors, respectively. The overall survival was not significantly influenced by surgical margins.

Conclusions: Managing malignant thoracic bone tumors poses significant challenges. This study underscores the criticality of achieving adequate margins, particularly after previous intralesional approaches.

Keywords: Bone tumor; En bloc spondylectomy; En bloc surgery; Thoracic bone tumors; Thoracic spondylectomy.