Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Oncologist. 2021 Oct;26(10):e1833-e1843. doi: 10.1002/onco.13840. Epub 2021 Jun 12.
The use of surgical metastasectomy (SM) has increased across cancer types in recent decades despite the increasing efficacy of modern systemic treatment modalities. Symptomatic spinal metastases severely compromise patients' performance status. However, as spinal SM is a complex surgery with potentially significant complications, it is not considered the treatment of choice.
We reviewed the articles on SM in several primary cancers with different types of metastatic lesions and extracted the data from relevant articles to provide a comprehensive review including the surgical techniques, indications, reported outcomes, and future prospects of SM in spinal metastases.
Total en bloc spondylectomy (TES) is a method of spinal SM associated with a lower risk of tumor recurrence and complications. Intralesional transpedicular osteotomy using a fine threadwire saw allows prevention of spinal cord and nerve root injuries. Spinal SM is considered suitable for patients with controlled primary disease having no evidence of disseminated extraspinal metastases, a completely resectable solitary lesion in the spine, and adequate cardiopulmonary reserve to tolerate the surgery. Metastatic lesions from kidney and thyroid cancers have been reported as the best candidates for spinal SM. Although data about spinal SM are limited, the reported outcomes are favorable with acceptable local recurrence rates in long-term follow-up.
In patients with isolated resectable spinal metastases, complete SM including TES is a useful option as it can improve function and survival. However, appropriate patient selection and surgical feasibility remain the most important aspects of management.
Surgical metastasectomy for spinal metastases may be a potentially curative treatment option with a low risk of local recurrence and lead to prolonged long-term survival if appropriate patients are selected and if the surgery is carried out by experienced surgeons in high-volume centers.
尽管现代系统治疗方式的疗效不断提高，但近几十年来，各种癌症类型的外科转移瘤切除术（SM）的应用有所增加。症状性脊柱转移严重影响患者的身体状况。然而，由于脊柱 SM 是一种复杂的手术，可能会有严重的并发症，因此它并不是首选的治疗方法。
我们回顾了几种原发性癌症中关于 SM 的文章，这些癌症有不同类型的转移性病变，并从相关文章中提取数据，提供了包括脊柱转移瘤 SM 的手术技术、适应证、报告结果以及未来前景的全面综述。
整块脊柱切除术（TES）是一种与较低的肿瘤复发和并发症风险相关的脊柱 SM 方法。使用细螺纹丝锯进行经椎间孔椎弓根内截骨术可防止脊髓和神经根损伤。脊柱 SM 被认为适用于原发疾病得到控制、无弥散性脊柱外转移证据、脊柱内完全可切除的孤立性病变以及心肺储备足以耐受手术的患者。来自肾和甲状腺癌的转移性病变已被报道为脊柱 SM 的最佳候选者。尽管有关脊柱 SM 的数据有限，但报告的结果是有利的，在长期随访中局部复发率可接受。
在孤立性可切除脊柱转移的患者中，包括 TES 在内的完全 SM 是一种有用的选择，因为它可以改善功能和生存。然而，适当的患者选择和手术可行性仍然是管理的最重要方面。
对于选择合适的患者，并在高容量中心由经验丰富的外科医生进行手术，脊柱转移瘤切除术（SM）可能是一种潜在的治愈性治疗选择，局部复发风险低，并可导致长期生存延长。
