title: Salvage Revision Surgery After Inappropriate Approach for Primary Spine Tumors: Long Term Follow-Up in 56 Cases.
abstract: BACKGROUND
  The mainstay treatment of primary malignant bone tumors is wide surgery in the spine. Unfortunately, most cases undergo the first approach in a nonspecialized center; this often means adopting an inappropriate approach with contamination, which consistently decreases the effectiveness of a second surgery. The aim of the present paper is to evaluate recurrence and survival rates after en-bloc resection.
  
  
  METHODS
  All patients underwent wide resection by the senior author from January 1997 to December 2013 after the first inappropriate approach was reviewed. Fifty-six patients were included in the present evaluation. Epidemiologic and clinical characteristics, surgeries, early and late complications, and survival rate were reported.
  
  
  RESULTS
  The margin obtained was wide, marginal, and intralesional in 9, 28, and 19 cases, respectively. The complication rates were 55.4% and 44.6% for early and late complications, respectively. Most (73.2%) of the patients had complications. The survival rate is 82.1% at 1 year and then decreases 10% each year until 42.1% at 5 years from surgeries. No statistically significant correlation was found between margin and local recurrence and survival.
  
  
  CONCLUSIONS
  In our series, the first inappropriate approach had already compromised patient prognosis, so in case of suspicious primary spine tumor, the patient had to be referred to a specialized center. The margin obtained during salvage surgery does not appear to influence recurrence and survival, probably because it is already compromised by the first surgery. More prospective studies are necessary to confirm our data and verify the impact of the margin obtained during salvage surgery on patients' survival.
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Luzzati
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Scotto
authors.affiliation: Oncological Orthopedics Department, Galeazzi Orthopedic Institute, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Perrucchini
authors.affiliation: Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Baaj
authors.affiliation: Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Rome, Italy. Electronic address: carminezoccali@libero.it.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality / Q000639:trends*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000401:mortality / Q000639:trends*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chondrosarcoma; Chordoma; Contamination; En-bloc vertebrectomy; Salvage surgery; Wide margin