Evolution of the Surgical Management of Lung Cancer Invading the Spine: A Single Center Experience

Abstract

For patients with locally advanced non-small cell lung cancer invading the spine, induction chemoradiotherapy combined with radical en bloc resection is the key to obtaining long-term survival. With time, our operative technique evolved to a two-step surgery as we experienced numerous perioperative complications during one step surgery. The aim of our study was to assess postoperative morbimortality and long-term survival of both techniques. We retrospectively reviewed all patients who underwent en bloc resection for lung cancer invading the spine between October 2012 and June 2020. Every patient underwent induction therapy. Sixteen patients were included: nine patients were operated on with one step surgery, seven patients were operated on with two step interventions. Twenty-five percent of patients had major perioperative complications and 56.2% of patients had major post-operative complications. Patients in the “one step” group tended to have more perioperative complications whereas patients in the “two step” group tended to have more post-operative complications. Overall 3-year survival was 40% in the one-step and 86% in the two-step surgery group. Although our practice has been improved by two-step interventions, post-operative morbidity remains significant. As long term survivals are encouraging, this type of treatment should still be proposed for highly selected patients, in specialized centers.

Treatments for Non-Small-Cell Lung Cancer: The Multiple Options for Precision Medicine

“…Another set of articles in this issue discuss the optimal management of patients with locally advanced disease. The first article by Drevet et al [ 3 ] focuses on tumors invading the cervical spine, whereas the work conducted by Martel-Lafay et al [ 4 ] deals with the management of unresectable stage III patients with peripheral primary tumors. Drevet et al [ 3 ] report a monocentric retrospective study evaluating two surgical techniques in this population.…”

“…The first article by Drevet et al [ 3 ] focuses on tumors invading the cervical spine, whereas the work conducted by Martel-Lafay et al [ 4 ] deals with the management of unresectable stage III patients with peripheral primary tumors. Drevet et al [ 3 ] report a monocentric retrospective study evaluating two surgical techniques in this population. For these patients with invasion of the cervical spine, multimodal treatments have demonstrated considerable improvements in survival, and the use of induction chemoradiotherapy combined with radical en bloc resection should be used to achieve complete resection.…”