title: Single Posterior Approach forEn-BlocResection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience.
abstract: METHODS
  Monocentric prospective study.
  
  
  OBJECTIVE
  To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.
  
  
  BACKGROUND
  In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "en-bloc" resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach.
  
  
  METHODS
  We included all patients who underwent posterioren-blocresection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation.
  
  
  RESULTS
  Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46-61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8-12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5-7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9-24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment.
  
  
  CONCLUSIONS
  The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.; Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sunna
authors.affiliation: Division of Thoracic Surgery, University of Montreal, Montreal, QC, Canada.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.affiliation: Division of Orthopaedic Surgery, University of Montreal, Montreal, QC, Canada.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Boubez
authors.affiliation: Division of Orthopaedic Surgery, University of Montreal, Montreal, QC, Canada.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shedid
keywords: Chemotherapy; Pancoast syndrome; Radiation therapy; Tumor resection