PDF(Pubmed)
Abstract：
BACKGROUND: Wide Surgery is the reference treatment for malignant and aggressive benign primary bone tumors in the spine. When located in the lumbar spine, En-Bloc Spondylectomy (EBS) remains a complex challenge. Moreover, surgery is complicated by the presence of the diaphragm in the thoracolumbar junction and the hinderance of the iliac wings at the lumbosacral levels. Therefore, EBS in the lumbar spine frequently requires combined approaches. The purpose of this study is to describe clinical presentation, tumor characteristics and results of a series of 47 consecutive patients affected by malignant primary bone tumors of the lumbar spine who underwent EBS.
METHODS: 47 patients were reviewed. Complications were distinguished in early and late whether they occurred before or after 30 days from surgery. Overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) were calculated by the Kaplan-Meier product-limit method from surgery until relapse or death.
RESULTS: 27 patients presented to observation after a first intralesional approach in a non-specialized center. Chordoma was the most represented histotype. Vertebrectomies were: 23 one-level, 10 two-level, 12 three-level and 2 four-level. Reconstructions were always carried out with screws and rods. The main postoperative complication was blood loss, while hardware failure was the main long-term complication. The 5-year LRFS was 75.5%, the 5-year DFS was 54.3%, and 5-year OS was 63.6%.
CONCLUSIONS: The surgical margin obtained during the index surgery was statistically associated with Local Recurrence, DFS and OS, underlining the importance of treating patients in reference centers.
METHODS: 47 patients were reviewed. Complications were distinguished in early and late whether they occurred before or after 30 days from surgery. Overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) were calculated by the Kaplan-Meier product-limit method from surgery until relapse or death.
RESULTS: 27 patients presented to observation after a first intralesional approach in a non-specialized center. Chordoma was the most represented histotype. Vertebrectomies were: 23 one-level, 10 two-level, 12 three-level and 2 four-level. Reconstructions were always carried out with screws and rods. The main postoperative complication was blood loss, while hardware failure was the main long-term complication. The 5-year LRFS was 75.5%, the 5-year DFS was 54.3%, and 5-year OS was 63.6%.
CONCLUSIONS: The surgical margin obtained during the index surgery was statistically associated with Local Recurrence, DFS and OS, underlining the importance of treating patients in reference centers.
摘要：
背景：宽手术是脊柱恶性和侵袭性良性原发性骨肿瘤的参考治疗方法。当位于腰椎时，En-Bloc脊椎切除术（EBS）仍然是一个复杂的挑战。此外，手术是复杂的，在胸腰椎交界处的隔膜的存在和在腰骶水平髂翼的阻碍。因此,腰椎中的EBS经常需要联合入路。这项研究的目的是描述临床表现，接受EBS治疗的47例腰椎恶性原发性骨肿瘤连续患者的肿瘤特征和结果。
方法：对47例患者进行回顾性分析。无论并发症发生在手术前30天还是手术后30天，都在早期和晚期进行区分。总生存期（OS），通过Kaplan-Meier乘积限制法计算从手术到复发或死亡的无病生存期(DFS)和无局部复发生存期(LRFS).
结果：27例患者在非专业中心进行首次病灶内治疗后接受观察。脊索瘤是最具代表性的组织型。椎体切除术为：23个一级，10两层，12个三级和2个四级。重建总是用螺钉和杆进行。术后主要并发症为失血,而硬件故障是主要的长期并发症。5年期LRFS为75.5%，5年DFS为54.3%，5年OS为63.6%。
结论：索引手术期间获得的手术切缘与局部复发有统计学关联，DFS和操作系统，强调在参考中心治疗患者的重要性。
方法：对47例患者进行回顾性分析。无论并发症发生在手术前30天还是手术后30天，都在早期和晚期进行区分。总生存期（OS），通过Kaplan-Meier乘积限制法计算从手术到复发或死亡的无病生存期(DFS)和无局部复发生存期(LRFS).
结果：27例患者在非专业中心进行首次病灶内治疗后接受观察。脊索瘤是最具代表性的组织型。椎体切除术为：23个一级，10两层，12个三级和2个四级。重建总是用螺钉和杆进行。术后主要并发症为失血,而硬件故障是主要的长期并发症。5年期LRFS为75.5%，5年DFS为54.3%，5年OS为63.6%。
结论：索引手术期间获得的手术切缘与局部复发有统计学关联，DFS和操作系统，强调在参考中心治疗患者的重要性。
