Systematic Review and Meta-analysis of En Bloc Vertebrectomy Compared with Intralesional Resection for Giant Cell Tumors of the Mobile Spine

Abstract

Study Design Systematic review and meta-analysis. Objective To compare the recurrence and perioperative complication rate of en bloc vertebrectomy (EV) and intralesional resection (IR) in the giant cell tumor of the mobile spine (SGCT). Methods We systematically searched publications in the PubMed and Embase databases for reports of SGCTs, excluding the sacrum. Two reviewers independently assessed all publications. A meta-analysis was performed using local recurrence and postoperative complications as the primary outcomes of interest. Results There were four articles reporting recurrence and two articles reporting postoperative complications. All included articles were case series. In all, 91 patients were included; 49 were treated with IR and 42 were treated with EV. Local recurrence rates were 36.7 and 9.5% in the IR and EV groups, respectively. Rates of postoperative complications were 36.4% with IR and 11.1% with EV. Overall, patients treated with EV not only had a lower recurrence rate (relative risk [RR] 0.22; 95% confidence interval [CI] 0.09 to 0.52) but also had a lower postoperative complication rate (RR 0.34; 95% CI 0.07 to 1.52) compared with IR. Conclusions Based on the limited data obtained from systematic review, SGCT patients treated with EV had a lower recurrence rate and fewer postoperative complications than those treated with IR.

Multiple segment total en bloc vertebrectomy and chest wall resection in a dog with an invasive myxosarcoma

“…In future cases, consideration should be given to using prosthetic mesh alone to reduce surgical time, a composite of a latissimus dorsi muscle flap and prosthetic mesh so that there are two supplementary reconstruction techniques in case one fails, or a latissimus dorsi myocutaneous flap, with or without additional prosthetic mesh, to improve perfusion of the latissimus dorsi muscle. Despite the risk of complications with total en bloc vertebrectomies with experienced surgeons in high‐volume centres, in one meta‐analysis, the postoperative complication rate was greater in patients treated with intralesional resections (36.4%) compared with patients treated with en bloc vertebrectomies (11.1%)13; so a less aggressive resection has minimal benefits with a higher complication rate and higher risk of local tumour recurrence.…”

“…Multiple studies have shown a significantly improved outcome in patients treated with en bloc vertebrectomy in comparison to less aggressive surgical techniques,7 11–19 even if histologic margins are incomplete 7 12 16. In one multicentre cohort study investigating the Enneking classification of surgical margins for resection of musculoskeletal tumours in the management of primary vertebral tumours,19 the local recurrence rate was significantly higher in patients in the Enneking inappropriate group (74%) compared with the Enneking appropriate group (20%).…”

“…En bloc vertebrectomy is defined as complete resection of all affected vertebra(e), including paraspinal muscles and ligaments, and adjacent anatomic barriers, without violation of the tumour capsule 6–10. Multiple studies have shown a significantly improved outcome in patients treated with en bloc vertebrectomy in comparison to less aggressive surgical techniques 7 11–19…”

Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases

“…and Charest‐Morin et al ., surgical margins have an important impact on local recurrence, and en bloc resection with wide/marginal margins may be associated with lower local recurrence and better prognosis7, 18. One systematic review and meta‐analysis also supported that SGCT patients treated with en bloc vertebrectomy had a lower recurrence rate19. Meanwhile, Boriani et al .…”

“…En bloc resection is associated with decreased local recurrence rate and mortality7, 18, 19. The management of recurrent SGCT is relatively difficult and there is little published literature on the subject11, 37.…”