• World Neurosurg · Feb 2021

    What predicts the prognosis of spinal metastases in separation surgery procedures?

    • Yining Gong, Jinxin Hu, Liang Jiang, Hongqing Zhuang, Feng Wei, Zhongjun Liu, Kaiwen Ni, Wenjie Bian, Yejun Wu, and Xiaoguang Liu.
    • Department of Orthopaedics, Peking University Third Hospital, Beijing, China; Health Science Center, Peking University, Beijing, China.
    • World Neurosurg. 2021 Feb 1; 146: e714-e723.

    BackgroundSeparation surgery is performed to provide a safe gap between the epidural tumor and spinal cord for postoperative stereotactic body radiotherapy (SBRT) in cases of spinal metastases. However, there is a gap in evidence regarding sufficient tumor resection in separation surgery. We describe the prognoses according to the extent of resection in separation surgery.MethodsThis retrospective study included 36 consecutive patients who underwent separation surgery and postoperative SBRT between December 2016 and December 2019 at a single center. Local control (LC), overall survival (OS), distance of separation (DS), and quality-of-life parameters were analyzed. P values <0.05 were considered statistically significant.ResultsPatients were assigned to the aggressive resection group (ARG, n = 18) or moderate resection group (MRG, n = 18), with estimated LC and OS at 1 year of 79.0% and 75.9%, respectively. There were no significant differences between ARG and MRG in estimated LC (85.9% vs. 72.2%; P = 0.317) or OS (69.3% vs. 80.9%, P = 0.953) at 1 year. All 5 patients in MRG who developed local progression had less satisfactory tumor resection with DS <3 mm. A borderline significant difference in estimated LC at 1 year was noted between individuals with DS <3 mm and those with DS ≥3 mm (51.9% vs. 100.0%; P = 0.053) in MRG. There was no statistical difference between ARG and MRG in quality-of-life parameters.ConclusionsModerate resection of ventral dural mass did not significantly reduce patients' prognosis in separation surgery. However, the minimal distance between the postoperative residual epidural tumor and spinal cord should be ≥3 mm.Copyright © 2020 Elsevier Inc. All rights reserved.

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