Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
Department of Orthopedics, The People's Hospital of Wenjiang Chengdu, Chengdu, 611130, China.
World J Surg Oncol. 2024 Aug 3;22(1):208. doi: 10.1186/s12957-024-03494-3.
This systematic review and meta-analysis aimed to consolidate the existing evidence regarding the comparison between en-bloc resection surgery and debulking surgery for spinal tumors, including both primary and metastatic tumors.
The databases of PubMed, Embase, Cochrane database, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was carried out and included all studies that directly compared en-bloc resection surgery with debulking surgery for spinal tumors in patients through March 2024. The primary outcomes included recurrence rate, postoperative metastasis rate, mortality rate, overall survival (OS), recurrence-free survival (RFS), complication, and so on. The statistical analysis was conducted using Review Manager 5.3.
We systematically reviewed 868 articles and included 27 studies involving 1135 patients who underwent either en-bloc resection surgery (37.89%) or debulking surgery (62.11%). Our meta-analysis demonstrated significant advantages of en-bloc resection over debulking surgery. Specifically, the en-bloc resection group had a lower recurrence rate (OR = 0.19, 95%CI: 0.13-0.28, P < 0.00001), lower postoperative metastasis rate (P = 0.002), and lower mortality rate (P < 0.00001). Additionally, en-bloc resection could improve OS and RFS (HR = 0.45, 95%CI: 0.32-0.62, P < 0.00001 and HR = 0.37, 95%CI: 0.17-0.80, P = 0.01, respectively). However, en-bloc resection required longer operative times and was associated with a higher overall complication rate compared to debulking surgery (P = 0.0005 and P < 0.00001, respectively).
The current evidence indicates that en-bloc surgical resection can effectively control tumor recurrence and mortality, as well as improve RFS and OS for patients with spinal tumors. However, it is crucial not to overlook the potential risks of perioperative complications. Ultimately, these findings should undergo additional validation through multi-center, double-blind, and large-scale randomized controlled trials (RCTs).
本系统评价和荟萃分析旨在整合现有关于整块切除术与肿瘤切除术治疗脊柱肿瘤（包括原发性和转移性肿瘤）的比较的证据。
我们对 PubMed、Embase、Cochrane 数据库、Web of Science、Scopus、中国知网（CNKI）、重庆维普数据库（VIP）和万方数据库进行了检索，并纳入了截至 2024 年 3 月直接比较脊柱肿瘤整块切除术与肿瘤切除术的所有研究。主要结局包括复发率、术后转移率、死亡率、总生存率（OS）、无复发生存率（RFS）、并发症等。采用 Review Manager 5.3 进行统计学分析。
我们系统地回顾了 868 篇文章，纳入了 27 项研究，共 1135 例患者接受了整块切除术（37.89%）或肿瘤切除术（62.11%）。我们的荟萃分析表明，整块切除术优于肿瘤切除术。具体而言，整块切除术组的复发率较低（OR=0.19，95%CI：0.13-0.28，P<0.00001），术后转移率较低（P=0.002），死亡率较低（P<0.00001）。此外，整块切除术可以提高 OS 和 RFS（HR=0.45，95%CI：0.32-0.62，P<0.00001 和 HR=0.37，95%CI：0.17-0.80，P=0.01）。然而，与肿瘤切除术相比，整块切除术需要更长的手术时间，且总并发症发生率更高（P=0.0005 和 P<0.00001）。
目前的证据表明，整块切除术可有效控制肿瘤复发和死亡率，提高脊柱肿瘤患者的 RFS 和 OS。然而，不能忽视围手术期并发症的潜在风险。最终，这些发现需要通过多中心、双盲、大规模随机对照试验（RCT）进一步验证。
