Zairi Fahed, Sunna Tarek, Liberman Moishe, Boubez Ghassan, Wang Zhi, Shedid Daniel
Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.; Department of Neurosurgery, Lille University Hospital, Lille, France.
Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.
Asian Spine J. 2016 Dec;10(6):1047-1057. doi: 10.4184/asj.2016.10.6.1047. Epub 2016 Dec 8.
Monocentric prospective study.
To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.
In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "" resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach.
We included all patients who underwent posterior resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation.
Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46-61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8-12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5-7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9-24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment.
The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.
单中心前瞻性研究。
评估后路手术切除晚期潘科斯特瘤的安全性和有效性。
对于侵犯脊柱的晚期潘科斯特瘤患者，大多数手术团队认为联合手术方式对于切除以控制内脏、血管和神经结构是必要的。我们报告了我们采用单阶段后路手术的初步经验。
我们纳入了2014年1月至2015年5月在我们机构接受后路切除侵犯脊柱的晚期潘科斯特瘤的所有患者。所有患者均为局部晚期肿瘤，无N2淋巴结转移或远处转移。除1例患者外，所有患者均受益于由同步化疗（顺铂 - 依托泊苷）和放疗组成的诱导治疗。
本研究纳入了5例患者。其中男性2例，女性3例，平均年龄55岁（范围46 - 61岁）。1例患者肿瘤累及2个相邻节段，1例患者累及3个节段，3例患者累及4个节段。术中无并发症发生。平均手术时间为9小时（范围8 - 12小时），平均估计失血量为3.2升（范围1.5 - 7升）。出院时无患者神经功能恶化。4例患者出现4种并发症。3种并发症需要再次手术，无一例致命。平均随访时间为15.5个月（范围9 - 24个月）。4例患者显微镜下切缘阴性（R0切除）且无疾病复发。1例患者显微镜下切缘阳性（R1切除），放疗后8个月出现局部复发。
后路手术是一种有价值的选择，避免了二期手术的需要。诱导放化疗非常适合降低局部复发风险。
