En Bloc Resection of Thoracic Tumors Invading the Spine: A Single-Center Experience

• Published in: The Annals of thoracic surgery Vol. 108; no. 1; pp. 227 - 234
• Main Authors: Zhang, Xiao-Miao, Fournel, Ludovic, Lupo, Audrey, Canny, Emelyne, Bobbio, Antonio, Lasry, Salomé, Regnard, Jean-François, Sailhan, Frederic, Alifano, Marco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2019
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2019.02.019

Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive operation remains controversial. The aim of this study was to characterize a single-center cohort and to evaluate the outcome, focusing on survival and complications. We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncologic and functional analysis. There were 31 patients operated on. An induction therapy was administered in 20 patients. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in 48.3% of the patients, and osteosynthesis was required in 22 patients. We observed no in-hospital death and a major complications rate of 32.3%, including 5 patients with early neurologic complications. There were 61.3% primary lung carcinomas, 12.9% extrapulmonary primaries, 9.7% metastases, and 16.1% benign tumors. Mean follow-up was 32.1 months. The 5-year overall survival rate was 81.3% in the entire cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall survival (p = 0.03). The 5-year disease-free survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients, including persistent neurologic deficit in 12.9%, instrumentation migration in 19.4%, and local infection in 12.9%. En bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical or infectious complications.