One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis
Study designRetrospective case series.ObjectiveTo describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.Summary of background dataTotal en bloc...
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| Format: | Article |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.844611/full |
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| author | Wei Xu Chen Ye Dan Zhang Peng Wang Haifeng Wei Xinghai Yang Jianru Xiao |
| author_facet | Wei Xu Chen Ye Dan Zhang Peng Wang Haifeng Wei Xinghai Yang Jianru Xiao |
| author_sort | Wei Xu |
| collection | DOAJ |
| description | Study designRetrospective case series.ObjectiveTo describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.Summary of background dataTotal en bloc spondylectomy (TES) technique is conventionally based on the single posterior approach or combined anterior-posterior approach. However, the single posterior approach imposes a high technical demand on the surgeon due to the narrow field of vision, limited surgical space and the delicate spinal cord, while the combined anterior-posterior approach not only requires greater patient tolerance but is time consuming and runs the risk of more blood loss and injury to the visceral pleura and large blood vessels during surgery. In addition, it is difficult to completely remove the thoracic CHS with paravertebral mass through simple en bloc resection when it involves the aorta, vena cava, costa and lung.Material and methodsBetween August 2010 and January 2016, we performed a retrospective study to evaluate the clinical characteristics and outcomes of en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. Postoperative recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. P values less than 0.05 were considered statistically significant.ResultsAltogether 15 patients received en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. The mean age of these patients was 37.0 ± 12.8 years (median 36; range 15–64). This combination approach provided more extensive exposure and wider marginal resection of the tumor within a mean operation duration of 288 ± 96 min (median 280; range 140–480) and mean intraoperative blood loss of 1,966 ± 830 ml (median 2,000; range 300–3,000). Of the 15 patients, 5 experienced local recurrence of the disease; the mean time from surgery to recurrence was 22 ± 9.85 months (median 17, range 13–35). RFS in patients with recurrent CHS was significantly lower than that in patients with primary CHS on admission (p = 0.05).ConclusionsThe combined posterior median and Wiltse approach is a technically viable option for en bloc resection of thoracic spinal CHS with huge paravertebral mass, and can give a favorable local control of CHS.Level of evidenceLevel V. |
| first_indexed | 2024-04-11T21:59:33Z |
| format | Article |
| id | doaj.art-792c0ada8f95490bb2a5403bcb34669e |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T21:59:33Z |
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| series | Frontiers in Surgery |
| spelling | doaj.art-792c0ada8f95490bb2a5403bcb34669e2022-12-22T04:01:00ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-08-01910.3389/fsurg.2022.844611844611One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracisWei Xu0Chen Ye1Dan Zhang2Peng Wang3Haifeng Wei4Xinghai Yang5Jianru Xiao6Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaDepartment of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, ChinaStudy designRetrospective case series.ObjectiveTo describe the technique details and therapeutic outcomes of 3-D printing model-guided en bloc resection of chondrosarcoma (CHS) with huge paravertebral mass via the combined posterior median and Wiltse approach.Summary of background dataTotal en bloc spondylectomy (TES) technique is conventionally based on the single posterior approach or combined anterior-posterior approach. However, the single posterior approach imposes a high technical demand on the surgeon due to the narrow field of vision, limited surgical space and the delicate spinal cord, while the combined anterior-posterior approach not only requires greater patient tolerance but is time consuming and runs the risk of more blood loss and injury to the visceral pleura and large blood vessels during surgery. In addition, it is difficult to completely remove the thoracic CHS with paravertebral mass through simple en bloc resection when it involves the aorta, vena cava, costa and lung.Material and methodsBetween August 2010 and January 2016, we performed a retrospective study to evaluate the clinical characteristics and outcomes of en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. Postoperative recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method. P values less than 0.05 were considered statistically significant.ResultsAltogether 15 patients received en bloc resection of thoracic spinal CHS with paravertebral mass through the combined posterior median and Wiltse approach. The mean age of these patients was 37.0 ± 12.8 years (median 36; range 15–64). This combination approach provided more extensive exposure and wider marginal resection of the tumor within a mean operation duration of 288 ± 96 min (median 280; range 140–480) and mean intraoperative blood loss of 1,966 ± 830 ml (median 2,000; range 300–3,000). Of the 15 patients, 5 experienced local recurrence of the disease; the mean time from surgery to recurrence was 22 ± 9.85 months (median 17, range 13–35). RFS in patients with recurrent CHS was significantly lower than that in patients with primary CHS on admission (p = 0.05).ConclusionsThe combined posterior median and Wiltse approach is a technically viable option for en bloc resection of thoracic spinal CHS with huge paravertebral mass, and can give a favorable local control of CHS.Level of evidenceLevel V.https://www.frontiersin.org/articles/10.3389/fsurg.2022.844611/fullEn blocCHSone-stageapproachprognosis |
| spellingShingle | Wei Xu Chen Ye Dan Zhang Peng Wang Haifeng Wei Xinghai Yang Jianru Xiao One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis Frontiers in Surgery En bloc CHS one-stage approach prognosis |
| title | One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| title_full | One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| title_fullStr | One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| title_full_unstemmed | One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| title_short | One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| title_sort | one stage en bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis |
| topic | En bloc CHS one-stage approach prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.844611/full |
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