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Surgical Outcomes of Vertebral Resection for Advanced Intrathoracic Malignant Disease
Carlos E. Bravo; Gita N. Mody; Katherine Armstrong; Mauricio Perez Martinez; Michael T. Jaklitsch
Brigham and Women's Hospital, Boston, MA, United States

Background: Resection of T4 intrathoracic cancers with direct invasion to the spine elicited creation of a surgical technique for resection that expanded indications for vertebrectomy to selected patients with lung cancer, sarcomas, and other metastatic disease. We review our experience to identify areas for clinical improvement.

Methods: Cases were identified using CPT codes for vertebrectomy cross-referenced with billing data from 2003-2014. Cases involving resection of malignancy invading at least one thoracic vertebra were selected.

Results: 32 patients median age 54 (range 18-77 years). 25 patients (78%) received preoperative chemoradiotherapy. 19 total and 13 partial vertebrectomies were performed. Average number of vertebrae resected was 1.6 (range 1-4). Median operative time 8.5 hours (range 2.8-14.5), mean blood loss 923ml (SD + 477 ml), and median LOS 8 days (range 3-56). Major morbidity followed 56% of cases. One non-ambulatory patient due to diffuse metabolic weakness; remaining were ambulatory. One reoperation 4 months postop for hardware migration. Discharges: home 69%, rehab 25%, and 1 patient (3%) to hospice after 56 days. 30-day mortality was 3% (PE). Median survival was 43.6 months and one-year survival was 73.5%

Conclusion:Vertebrectomy for malignant disease is feasible for T4 tumors. Our one stage/two team approach allows completion of the operation within a standard day, but is associated with long operative time. Median long term survival exceeded 3.5 years. Future prospective studies are warranted.

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