J Korean Soc Spine Surg.  2019 Dec;26(4):117-125. 10.4184/jkss.2019.26.4.117.

Clinical Significance of Resection Type and Margin following Surgical Treatment for Primary Sarcoma of the Spine: A Multi-Center Retrospective Study

• Chang SY
• Kim H
• Park SJ
• Chang BS
• Lee CS
• Lee CK

• KMID: 2467940
• DOI: http://doi.org/10.4184/jkss.2019.26.4.117

Abstract

STUDY DESIGN: A retrospective multi-center study.
OBJECTIVES
To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma. SUMMARY OF LITERATURE REVIEW: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy.
MATERIALS AND METHODS
We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test.
RESULTS
Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004).
CONCLUSIONS
Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma.

Keyword

Primary spinal sarcoma; En bloc resection; Survival; Recurrence; Metastasis

MeSH Terms

Chondrosarcoma
Cohort Studies
Diagnosis
Follow-Up Studies
Humans
Neoplasm Metastasis
Osteosarcoma
Recurrence
Retrospective Studies*
Sarcoma*
Spine*

Figure

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  Fig. 1. Distribution of patients according to the type of surgical resection and surgical margin.

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  Fig. 2. Kaplan-Meier survival curve of the total cohort showing an improvement in overall postoperative survival in patients who underwent total en bloc resection and had a negative margin

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  Fig. 3. (A) Kaplan-Meier survival curve for local recurrence showing significantly less recurrence in patients who underwent total en bloc re-section with a negative margin (p=0.004, log-rank test). (B) Kaplan-Meier survival curve for distant metastasis showing significantly less metastasis in patients who underwent total en bloc resection with a negative margin (p=0.025, log-rank test).

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  Fig 4. (A–D) A 63-year-old woman was diagnosed with osteosarcoma at the T7 level, which encased the descending thoracic aorta over the T5–8 levels. (E, F) The patient underwent total en bloc resection of the tumor, combined with replacement of the descending thoracic aorta by a thoracic surgeon. The postoperative X-ray is shown. (G, H) The specimen from the operation is shown. The patient experienced transient paraplegia due to spinal cord infarction, and currently ambulates using a walker. The patient had no evidence of disease after 4 years of follow-up.

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