Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
BMC Musculoskelet Disord. 2024 Mar 26;25(1):237. doi: 10.1186/s12891-024-07353-w.
En bloc resection of spinal tumors is challenging and associated with a high incidence of complications; however, it offers the potential to reduce the risk of recurrence when a wide margin is achieved. This research aims to investigate the safety and efficacy of en bloc resection in treating thoracic and lumbar chondrosarcoma/chordoma.
Data from patients diagnosed with chondrosarcoma and chordoma in the thoracic or lumbar region, who underwent total en bloc or piecemeal resection at our institution over a 7-year period, were collected and regularly followed up. The study analyzed overall perioperative complications and compared differences in complications and local tumor recurrence between the two surgical methods.
Seventeen patients were included, comprising 12 with chondrosarcoma and 5 with chordoma. Among them, 5 cases underwent intralesional piecemeal resection, while the remaining 12 underwent planned en bloc resection. The average surgical time was 684 min (sd = 287), and the mean estimated blood loss was 2300 ml (sd = 1599). Thirty-five complications were recorded, with an average of 2.06 perioperative complications per patient. 82% of patients (14/17) experienced at least one perioperative complication, and major complications occurred in 64.7% (11/17). Five patients had local recurrence during the follow-up, with a mean recurrence time of 16.2 months (sd = 7.2) and a median recurrence time of 20 months (IQR = 12.5). Hospital stays, operation time, blood loss, and complication rates did not significantly differ between the two surgical methods. The local recurrence rate after en bloc resection was lower than piecemeal resection, although not statistically significant (P = 0.067).
The complication rates between the two surgical procedures were similar. Considering safety and local tumor control, en bloc resection is recommended as the primary choice for patients with chondrosarcoma/chordoma in the thoracic and lumbar regions who are eligible for this treatment.
整块切除脊柱肿瘤具有挑战性，且并发症发生率较高；然而，当达到广泛切缘时，它有可能降低复发风险。本研究旨在探讨整块切除治疗胸腰椎脊索瘤/软骨肉瘤的安全性和有效性。
收集我院 7 年内诊断为胸腰椎脊索瘤/软骨肉瘤并接受整块或分块切除术的患者数据，并进行定期随访。本研究分析了围手术期总体并发症，并比较了两种手术方法的并发症和局部肿瘤复发差异。
共纳入 17 例患者，其中软骨肉瘤 12 例，脊索瘤 5 例。5 例患者行肿瘤内部分切除术，12 例患者行计划整块切除术。平均手术时间为 684 分钟（标准差=287），平均估计失血量为 2300 毫升（标准差=1599）。记录到 35 种并发症，平均每位患者有 2.06 种围手术期并发症。82%（17/17）的患者至少发生 1 种围手术期并发症，64.7%（11/17）的患者发生严重并发症。17 例患者中有 5 例在随访期间发生局部复发，平均复发时间为 16.2 个月（标准差=7.2），中位复发时间为 20 个月（IQR=12.5）。两种手术方法的住院时间、手术时间、失血量和并发症发生率无显著差异。整块切除后局部复发率低于分块切除，但无统计学意义（P=0.067）。
两种手术方式的并发症发生率相似。考虑到安全性和局部肿瘤控制，整块切除是适合胸腰椎脊索瘤/软骨肉瘤患者的首选治疗方法。
