Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis

Abstract

Purpose:Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast with intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedure. Methods:A systematic search was performed on EBSCO, PubMed and Web of Science, between 1966 and 2018, to identify studies evaluating patients submitted to resection of primary osteosarcoma of the spine. Two reviewers independently assessed all reports. The outcomes were local recurrence, metastases development and survival at 12, 24 and 60 months. Results:Five studies (108 patients) were included for systematic review. These studies support the conclusion that EA procedure has a lower local recurrence rate (RR: 0.33, 95% CI: 0.17-0.66), a lower metastases development rate

Behandlungsalternativen für sakrale Chordome

“…Der Resektionsrand kann daher als Enneking appropriate (EA)eine marginale oder eine weite Resektion oder als Enneking inappropriate (EI)eine intraläsionale oder eine kontaminierte Resektion bezeichnet werden [19]. Eine EA Resektion führt zur einen deutlichen Reduktion der Rezidivrate und Metastasierung sowie zur Verlängerung des Gesamtüberlebens [20,21].…”

Surgical Advances in Osteosarcoma

“…Spinal OS is rare accounting for less than 5% of malignant tumours of the spine [168]. They are aggressive with an overall median survival of 6.7 years [169].…”

“…Surgical excisions are termed Enneking appropriate (for en-bloc resection with marginal margin) or Enneking inappropriate (positive margin at histology). Reduced local recurrence and longer disease-free survival is achieved with Enneking appropriate resections [168,169].…”

The Combination of Separation Surgery and Intensity Modulated Radiation Therapy (IMRT) for a Primary Osteosarcoma of the Spine: A Case Report and Literature Review

“… 1 Recent studies suggested that primary malignant spinal tumors including osteosarcoma should undergo en bloc resection to reduce local recurrence and achieve a complete cure with longer survival. 1 - 5 Although total en bloc spondylectomy (TES) 6 , 7 can achieve marginal resection of tumors, this procedure requires sacrifice of nerve root and carries major risks, including massive bleeding, spinal cord injury, pleural effusion, and postoperative cerebrospinal fluid leakage. 3 , 8 However, complete marginal resection is not always achievable due to adjacent neurovascular components and impending neurological dysfunction sometimes makes it impossible to perform neoadjuvant therapies aiming for maximizing the chance of marginal resection.…”