En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery

Abstract

Study Design Retrospective case series. Purpose To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. Overview of Literature Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. Methods We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40–77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan–Meier method, and groups were compared using the log-rank method. Results The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71–39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. Conclusions Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.

Comparison of Surgical Outcomes Between Separation Surgery and Piecemeal Spondylectomy for Spinal Metastasis: A Retrospective Analysis

“…Although total en bloc spondylectomy is considered an ideal choice for patients with solitary spinal metastasis, the complex surgical procedure has limited the practicality of this method. In addition, Ohashi et al showed that 72.2% of patients experienced distant dissemination after en bloc resection in the long-term follow-up (>48 months) ( 26 ), indicating that en bloc resection is unable to prevent distant relapse despite the low rate of local recurrence. Moreover, compared with debulking, en bloc surgery showed similar survival outcomes, neurological improvements, and complication rates ( 27 ).…”

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

“…Favorable outcomes in this regard have been reported in the literature [ 74 - 76 ]. However, some authors recently reported that curative surgical resection (en bloc spondylectomy) did not impact the oncologic outcomes of spinal metastasis patients [ 77 ]. Therefore, a more careful and thorough decision-making process is required before performing curative resection surgery for spinal metastasis, especially when the extended role of radiosurgery is considered.…”

Surgical Metastasectomy in the Spine: A Review Article

“…Contrary to the expectations of most clinicians, the development of effective and modern systemic treatment modalities has increased the number of spinal SM and the publication of related articles, especially in Asian countries [33–36, 68, 73, 77–82, 99–102]. Although the number of candidates with an indication for spinal SM is still limited among patients with spinal metastases, we expect these to increase, especially in countries where SBRT is not widely available.…”