Early Surgical Outcomes of En Bloc Resection Requiring Vertebrectomy for Malignancy Invading the Thoracic Spine

Mody, Gita N.; Iñiguez, Carlos Bravo; Armstrong, Katherine; Martinez, Mauricio Perez; Ferrone, Marco; Bono, Christopher M.; John, H.; Wee, Jon O.; Lebenthal, Abraham; Swanson, Scott J.; Colson, Yolonda L.; Bueno, Raphael; Jaklitsch, Michael T.

doi:10.1016/j.athoracsur.2015.05.113

Cited by 18 publications

(24 citation statements)

References 15 publications

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“…Mean blood loss after surgical decompression of spinal tumors ranges from 500 to 2300 mL and these procedures are associated with high transfusion rates. 1,20,41-43 Minimizing blood loss and perioperative transfusions not only reduces health care costs 14,15,44,45 but may also play a role in reducing perioperative mortality. 46-50 Perioperative transfusion of allogeneic blood has also been associated with higher infection rates following various orthopedic procedures, 48,51-55 and in this study, 48.6% of patients with perioperative sepsis had received a perioperative blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases

Hussain

Cheung

Vig

et al. 2018

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: Malnutrition has been shown to be a risk factor for poor perioperative outcomes in multiple surgical subspecialties, but few studies have specifically investigated the effect of hypoalbuminemia in patients undergoing operative treatment of metastatic spinal tumors. The aim of this study was to assess the role of hypoalbuminemia as an independent risk factor for 30-day perioperative mortality and morbidity after surgical decompression of metastatic spinal tumors using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2014. Methods: We identified 1498 adult patients in the ACS-NSQIP database who underwent laminectomy and excision of metastatic extradural spinal tumors. Patients were categorized into normoalbuminemic and hypoalbuminemic (ie, albumin level <3.5 g/dL) groups. Univariate and multivariate regression analyses were performed to examine the association between preoperative hypoalbuminemia and 30-day perioperative mortality and morbidity. Subgroup analysis was performed in the hypoalbuminemic group to assess the dose-dependent effect of albumin depletion. Results: Hypoalbuminemia was associated with increased risk of perioperative mortality, any complication, sepsis, intra- or postoperative transfusion, prolonged hospitalization, and non-home discharge. However, albumin depletion was also associated with decreased risk of readmission. There was an albumin level–dependent effect of increasing mortality and complication rates with worsening albumin depletion. Conclusions: Hypoalbuminemia is an independent risk factor for perioperative mortality and morbidity following surgical decompression of metastatic spinal tumors with a dose-dependent effect on mortality and complication rates. Therefore, it is important to address malnutrition and optimize nutritional status prior to surgery.

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Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases

Hussain

Cheung

Vig

et al. 2018

Global Spine Journal

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“…Mody et al reported on a large case series of extended resection for tumor invading the thoracic spine and requiring vertebrectomy. Sarcoma was present in 9 of the 32 cases with 82% achieving an R0 resection [55]. …”

Section: Complex Managementmentioning

confidence: 99%

Management of Sarcoma Metastases to the Lung

Digesu

Wiesel

Vaporciyan

et al. 2016

Surgical Oncology Clinics of North America

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Synopsis Pulmonary metastases are a common manifestation of sarcoma that requires special attention. For decades, surgical resection of pulmonary metastases has been performed, and despite limited randomized data, surgery is increasingly accepted as an integral part in the management of metastatic disease. Although sarcoma is heterogeneous, common prognostic factors have been identified to guide surgeons prior to pulmonary metastasectomy including long disease-free interval, ability to obtain a complete resection, and extra-pulmonary disease control. Patients with adequate pulmonary reserve may undergo resection via thoracotomy or in select cases video-assisted thoracoscopic surgery (VATS). Long-term results indicate resection is potentially curative with significantly improved survival following complete resection. Recurrence, however, is not uncommon with many patients undergoing repeat resection. With advancing surgical technique and adjuvant therapies, patients with high or recurrent tumor burden are increasingly afforded disease control and potential cure. In this review, the prognostic characteristics of pulmonary metastases from sarcoma, pre-operative evaluation, operative technique, long-term outcomes, and management of complex patients are highlighted.

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“…Later, Smitherman et al applied frameless stereotactic navigation to complete a multi-level sagittal vertebral osteotomy for a giant cell tumor, claiming that real-time three-dimensional imaging made the procedure possible by avoiding adjacent critical vascular structures [ 15 ]. Furthermore, Mody et al contributed to the sequence of en bloc resection by splitting up the procedure into two stages, allowing for completion in a standard day [ 16 ]. Kobayashi et al, who published their case report just a few days after we performed our case, applied the use of an O-Arm stereotactic navigation system to partial vertebrectomy for lung cancer adjacent to the thoracic spine, stating the O-Arm permitted accurate confirmation of the surgical margins of the osteotomy via a posterior approach [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Utilizing Stereotactic Spine Navigation for Posterior Partial Vertebrectomy in an En Bloc Resection of a Superior Pulmonary Sulcus Tumor Invading the Thoracic Vertebrae: A Technical Note

Ziu

Traylor

Paxman

et al. 2018

Cureus

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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.

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Early Surgical Outcomes of En Bloc Resection Requiring Vertebrectomy for Malignancy Invading the Thoracic Spine

Cited by 18 publications

References 15 publications

Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases

Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases

Management of Sarcoma Metastases to the Lung

Utilizing Stereotactic Spine Navigation for Posterior Partial Vertebrectomy in an En Bloc Resection of a Superior Pulmonary Sulcus Tumor Invading the Thoracic Vertebrae: A Technical Note

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