Early Surgical Outcomes of En Bloc Resection Requiring Vertebrectomy for Malignancy Invading the Thoracic Spine.
BACKGROUND
En bloc vertebral resection of locally invasive T4 lung cancers led to the development of a surgical sequence for resection; posterior stabilization, reposition, thoracotomy, lobectomy, vertebrectomy, and anterior spine stabilization in 1 procedure. This technique expanded indications for vertebrectomy to selected patients with sarcoma and metastatic disease. We review our experience to identify areas for clinical improvement.


METHODS
Operative case logs were cross-checked with billing data from 2003 to 2014 with Current Procedural Terminology (CPT, American Medical Association) codes for vertebrectomy. Thirty-two cases involving en bloc resection of malignancy invading at least 1 thoracic vertebra were selected. Outcomes data were analyzed using summary statistics.


RESULTS
Series includes 14 men and 18 women, median age 50 years. Twenty-five patients (78%) received preoperative chemoradiation. Nineteen total and 13 partial vertebrectomy were performed. Average number of vertebrae resected was 1.6 (range, 1 to 4). Median operative length was 8.5 hours (range, 2.8 to 14.5), mean blood loss 923 mL (SD ± 477 mL), and median length of stay 8 days (range, 3 to 56). Major morbidity followed 56% of cases. Thirty-day mortality was 3%. Overall median survival was 43.6 months, 1-year survival was 73.6%, and 5-year survival was 40.3%.


CONCLUSIONS
En bloc vertebrectomy for malignant disease is feasible. Our 1 stage and 2 team approach allows completion of the operation within a standard day, but is associated with long operative time. Complication rates may improve with decreased operative times. Review of available data warrants future prospective studies.
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: gmody@partners.org.
Gita N
GN
Mody
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Carlos
C
Bravo Iñiguez
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Katherine
K
Armstrong
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Mauricio
M
Perez Martinez
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Marco
M
Ferrone
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Christopher
C
Bono
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
John H
JH
Chi
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Jon O
JO
Wee
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Abraham
A
Lebenthal
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Scott J
SJ
Swanson
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Yolonda L
YL
Colson
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Raphael
R
Bueno
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Michael T
MT
Jaklitsch
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019637:Orthopedic Procedures / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods*; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult