Ziu Mateo, Traylor Jeffrey I, Paxman Jason, Gorrebeeck Allison, Fortes Daniel L
Department of Surgery & Perioperative Care, The University of Texas at Austin, Dell Medical School, Austin, USA.
Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA.
Cureus. 2018 Sep 14;10(9):e3303. doi: 10.7759/cureus.3303.
Prior to the development of en bloc techniques, vertebral invasion by non-small cell lung cancer (NSCLC) had been considered a relative contraindication to surgical intervention. However, reports in the literature have demonstrated increased progression-free survival with the use of neoadjuvant chemotherapy followed by anterior en bloc resection of the residual tumor. Stereotactic spine navigation has been shown to improve accuracy during complex vertebral osteotomies, improving patient outcomes. We report a 53-year-old woman with an NSCLC in the left upper lobe, a periosteum attachment of the second and third thoracic vertebrae (T2 and T3, respectively), and an infiltration of the corresponding nerve roots. We describe a surgical approach for the resection of NSCLC with vertebral infiltration utilizing stereotactic spine navigation and intraoperative computed tomography (CT) (O-Arm, Medtronic, Minneapolis, Minnesota, US) for a posterior approach laminectomy, osteotomy, and partial vertebrectomy, followed by trans-thoracic en bloc resection of a superior pulmonary sulcus tumor with nerve root infiltration. Posterior approach vertebral osteotomy and en bloc resection for superior sulcus NSCLC infiltrating the vertebrae utilizing stereotactic spine navigation and intraoperative CT (O-Arm) is a viable alternative to the traditional anterior approach.
在整块切除技术发展之前，非小细胞肺癌（NSCLC）侵犯椎体一直被视为手术干预的相对禁忌证。然而，文献报道显示，新辅助化疗后行残留肿瘤整块前路切除可提高无进展生存期。立体定向脊柱导航已被证明可提高复杂椎体截骨术的准确性，改善患者预后。我们报告了一名53岁女性，左上叶患有NSCLC，第二和第三胸椎（分别为T2和T3）有骨膜附着，相应神经根有浸润。我们描述了一种利用立体定向脊柱导航和术中计算机断层扫描（CT）（美国明尼苏达州明尼阿波利斯美敦力公司的O型臂）进行后路椎板切除术、截骨术和部分椎体切除术，切除浸润椎体的NSCLC的手术方法，随后经胸整块切除侵犯神经根的肺上沟肿瘤。利用立体定向脊柱导航和术中CT（O型臂）对浸润椎体的肺上沟NSCLC进行后路椎体截骨术和整块切除术是传统前路手术的可行替代方案。
