En-bloc resection of thoracic tumors invading the spine: a single-center experience.

BACKGROUND: Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive surgery remains controversial. The aim of this study was to characterize a single-center cohort, and to evaluate the outcome, focusing on survival and complications.

METHODS: We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En-bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncological and functional analysis.

RESULTS: 31 patients were operated on. An induction-therapy was administered in 20 cases. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in almost half cases; osteosynthesis was required in 22 patients. We observed no in-hospital death, and a major complications rate of 32.3% including 5 cases of early neurological complications. There were 61.3% primary lung carcinomas, 12.9% extra-pulmonary primaries, 9.7% metastases and 16.1% benign tumors. Mean follow-up was 32.1 months. Five-year overall-survival-rate was 81.3% in the whole cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall-survival (p=0.03). Five-year disease-free-survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients including persistent neurologic deficit (12.9%), instrumentation migration (19.4%), and local infection (12.9%).

CONCLUSIONS: En-bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical and/or infectious complications.