Anterior approaches to the thoracic spine in patients with cancer: indications and results.
BACKGROUND
Multidisciplinary surgical teams enable an aggressive approach to tumors involving the thoracic spine.


METHODS
From February 1994 to July 1996, 61 patients underwent anterior resections of thoracic spine tumors. Their median age was 56 years. The indications for operation were curative in intent in 7 of 61 and palliative in 54 of 61 (to relieve intractable metastatic bone pain with neurologic compromise [n = 38] and pain alone [n = 16]). Sixteen patients came to our institution unable to ambulate with impending paraplegia.


RESULTS
Anterior approaches included combined left side of the neck and median sternotomy for lesions involving vertebrae T-1 through T-3 (n = 9), posterolateral thoracotomy for T-3 through T-10 (n = 39), and thoracoabdominal approach at T-11 and T-12 (n = 13). Median hospital stay was 9.0 days (range, 4 to 57 days). Complications occurred in 18 of 61 (29.5%). In 55 of 61 (90%), pain was significantly improved after the operation. Twelve of the 16 patients who initially presented in wheelchairs regained ambulatory function. There were five perioperative deaths (8.2%). The 1-year cumulative survival for the entire group was 60%.


CONCLUSIONS
An aggressive surgical approach in cancer patients with locally advanced or metastatic disease in the thoracic spine was associated with acceptable morbidity and mortality. There was significant improvement in their quality of life by control of intractable pain in 90% and recovery of ambulatory function in 75% of patients who presented with critical spinal cord compromise.
Walsh
G L
GL
Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Gokaslan
Z L
ZL
McCutcheon
I E
IE
Mineo
M T
MT
Yasko
A W
AW
Swisher
S G
SG
Schrump
D S
DS
Nesbitt
J C
JC
Putnam
J B
JB
Roth
J A
JA
D006801:Humans; D007902:Length of Stay; D008722:Methods; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery; D010166:Palliative Care; D010348:Patient Care Team; D011183:Postoperative Complications; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013908:Thoracotomy; D013909:Thorax