En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature.
ABSTRACT Survival data and rates of recurrence after en bloc resection for cervical spinal tumors are limited to single case reports and small case series, making the true risk of recurrence after this procedure unknown.
To report two cases of cervical chordoma managed via en bloc resection. To conduct a systematic review of the existing literature to determine the overall incidence of disease-free survival and investigate potential prognostic factors of recurrence.
Case report and systematic review.
We present the cases of a 60-year-old woman and a 76-year-old man who underwent en bloc resection of C3-C6 and C2 chordomas, respectively. A complete MEDLINE search was then undertaken for all articles reporting survival data for en bloc resections of primary tumors of the cervical spine. Exclusion criteria included non-English articles, lack of explicit mention or description of en bloc technique, age less than 16, no demographic or survival information reported, and follow-up less than 1 month. Survivorship analysis was conducted, and Kaplan-Meier plots were created with the primary outcome of interest being any tumor recurrence.
A total of 10 articles comprising 18 cases were included for analysis with a mean follow-up of 47.4+/-41.5 months. Mean operative time, estimated blood loss, and length of hospitalization were 18.6 hours, 2.9L, and 34.6 days, respectively. Postoperative complications occurred in eight of the nine patients in which these data were reported. There were three cases of local recurrence, occurring at 12, 44, and 113 months, and one case of distant metastasis, occurring at 12 months postoperatively. With the available data, 1- and 5-year disease-free survival rates of 88.2% and 73.5% were calculated. On Cox proportional hazards analysis, no factors were found to be predictive of recurrence.
In this systematic review of the literature, en bloc resection provided good disease-free survival rates in patients with primary tumors of the cervical spine. However, there are insufficient data on long-term subjective outcomes in these patients, and larger series are needed to determine the efficacy compared with piecemeal resection techniques. Other investigators should be encouraged to publish their results so that combined analyses like these may be performed with larger sample sizes.
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ABSTRACT: Many studies have found that patients admitted on the weekend have inferior outcomes compared with those admitted on a weekday, which may be due partially to decreased availability of procedures. To evaluate the impact of weekend admission on the timing of intervention and outcomes after surgery for metastatic spine disease. Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Patients were included if they had metastatic disease and underwent spine surgery; elective hospital admissions were excluded. Multivariate logistic regression analyses were conducted to calculate the odds of undergoing early surgery, in-hospital death, and the development of a complication for patients admitted on the weekend compared with those admitted on a weekday. All analyses were adjusted for differences in age, sex, comorbid disease, primary tumor histology, myelopathy, visceral metastases, and expected primary payer, as well as hospital volume, bed size, and teaching status. We evaluated 2714 admissions. Weekend admission was associated with a significantly lower adjusted odds of receiving surgery within 1 day (odds ratio, 0.66, 95% confidence interval, 0.54-0.81; P < .001) and within 2 days (odds ratio, 0.68; 95% confidence interval, 0.56-0.83; P < .001) of admission. The adjusted odds of in-hospital death and developing a postoperative complication were not significantly different for those admitted on the weekend. In this nationwide study examining patients with spinal metastases, those admitted on the weekend were significantly less likely to receive early intervention. Future studies are needed to delineate the reasons for differences in the timing of surgery.Neurosurgery 08/2011; 70(3):586-93. DOI:10.1227/NEU.0b013e318232d1ee · 3.03 Impact Factor