Feasibility and Safety of En Bloc Resection for Primary Spine Tumors
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Notice bibliographique
Résumé
In Brief Study Design. Systematic review. Objectives. To determine the general feasibility and safety of en bloc resection for primary spine tumors by analyzing (1) the effect of incisional biopsy performed before definitive en bloc resection and (2) the rate of achievement of disease-free margins, morbidity, mortality, and health resource utilization. Summary of Background Data. The feasibility of en bloc resection is determined by careful surgical and oncologic staging, and a key step in this process is obtaining a tissue diagnosis. There is currently good evidence to support the premise that the best chance for surgical cure in primary tumors of the spine is by en bloc resection with disease-free margins; however, the early morbidity of these procedures begs the question of whether they are justified. Methods. A formal systematic review with search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases was undertaken. Included reports described patients with low grade malignant spine tumors, the method of staging and surgical resection, and the complications. Two blinded, independent reviewers used a standardized study selection worksheet. Results. About 89 articles were identified, with 8 selected after excluding small case series and studies that included other pathologies (e.g., metastatic disease). Weinstein, Boriani, Biagini staging accurately predicted the attainment of wide or marginal en bloc resection in 88% of cases. There was a clear increase in tumor recurrence when intralesional procedures were performed before the definitive en bloc resection. Tumor recurrence significantly shortened patient survival. Surgical complication rates ranged from 13% to 56% and mortality ranged from 0% to 7.7%. Conclusion. (1) Incisional biopsy or intralesional resection significantly increases the risk of local recurrence, therefore, transcutaneous computed tomography-guided trocar biopsy is recommended. When there is a suspicion of primary spine tumor, the surgeon who performs the definitive surgery should ideally perform or direct the biopsy procedure. (2) En bloc resection is achievable if staging determines that it is feasible. The adverse event profile of these surgeries is high even at experienced centers. Therefore, experienced, multidisciplinary teams should perform these surgeries. (3) Grade of Recommendation can be “strong recommendation, low-quality evidence.” A systematic review was performed to determine (1) the effect of incisional procedures prior en bloc resection for primary spine tumors and (2) the rate of achievement of disease-free margins, morbidity, and mortality. There was a clear increase in tumor recurrence after intralesional procedures. Weinstein, Boriani, Biagini staging accurately predicted disease-free margins in the majority of cases. The adverse event profile of en bloc resection is high even at experienced centers.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle