title: En Bloc Resections in the Spine: The Experience of 220 Patients During 25 Years.
abstract: OBJECTIVE
  En bloc resections aim at surgically removing a tumor in a single, intact piece. Approach must be planned for the complete removal of the tumor without violation of its margins. The shared knowledge of the morbidity, mortality, risk assessment for local disease recurrence, complications, and death, related to spine tumors excised en bloc could improve the treating physician's apprehension of the diseases and decision making process before, during, and after surgical treatment. The purpose of this study was to review and report the experience gained during 25 years in one of the world's biggest spine oncologic centers.
  
  
  METHODS
  A retrospective study of prospective collected data of 1681 patients affected by spine tumors, of whom 220 had en bloc resections performed.
  
  
  RESULTS
  Most tumors were primary-165 cases (43 benign and 122 malignant); metastases occurred in 55 patients. A total of 60 patients died from the disease and 33 local recurrences were recorded. A total of 153 complications were observed in 100 of 216 patients (46.2%); 64 of these patients (30%) suffered 1 complication, whereas the rest had 2 or more. All complications were categorized according to temporal distribution and severity. These were further divided into 7 groups according to the type of complication. There were 105 major and 48 minor complications. Seven patients (4.6%) died as a result of complications. There were 33 local recurrences (15.28%) recorded. Contaminated cases, surgical margins of the resected tumor-intralesional, marginal, and malignant tumors-were statistically significant independent risk factors for local recurrence of the tumor. Contamination, local recurrence, neoadjuvant radiotherapy, number of levels resected, and metastatic tumors compared with primary malignant tumor were shown to be independent risk factors for a patient's death.
  
  
  CONCLUSIONS
  Treatment of spinal aggressive benign and malignant bone tumors with en bloc resection is beneficial in terms of better local control and prognosis, although it is a highly demanding and risky procedure. Margins are the key point of this procedure, thus a careful preoperative oncologic and surgical staging is necessary to define the optimal surgical approach. The adverse event profile of these surgeries is high. Therefore, it should be performed by experienced and multidisciplinary teams in specialized high volume centers.
authors: Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy.
authors: Stefano
authors: S
authors: Boriani
authors: Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy.
authors: Alessandro
authors: A
authors: Gasbarrini
authors: Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy.
authors: Stefano
authors: S
authors: Bandiera
authors: Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy.
authors: Riccardo
authors: R
authors: Ghermandi
authors: Unit of Spine Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel. Electronic address: ranilador@gmail.com.
authors: Ran
authors: R
authors: Lador
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000639:trends*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: En bloc resection; Morbidity; Spine tumors; Surgical planning