Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis.

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Abstract

[Indexed for MEDLINE] 2. Eur Spine J. 2023 Mar;32(3):994-1002. doi: 10.1007/s00586-022-07505-3. Epub 2023 Jan 2. Gross total resection of spinal chondrosarcoma is associated with improved locoregional relapse-free survival and overall survival. Abunimer AM(#)(1)(2), Hammoudeh L(#)(3), Dee EC(4), Lak AM(1), Chi J(1), Lu Y(1), Groff M(1), Shin JH(5), Lam MB(#)(6), Zaidi HA(#)(7). Author information: (1)Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA. (2)Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar. (3)Department of Radiation Medicine, The Oregon Health & Science University Hospital, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA. (4)Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. (5)Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. (6)Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Dana Farber Cancer Institute, Boston, USA. miranda_lam@dfci.harvard.edu. (7)Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA. hzaidi1@bwh.harvard.edu. (#)Contributed equally BACKGROUND: Spinal chondrosarcomas are rare malignant osseous tumors. The low incidence of spinal chondrosarcomas and the complexity of spine anatomy have led to heterogeneous treatment strategies with varying curative and survival rates. The goal of this study is to investigate prognostic factors for locoregional recurrence-free survival (LRFS) and overall survival (OS) comparing en bloc vs. piecemeal resection for the management of spinal chondrosarcoma. METHODS: We retrospectively identified patients who underwent curative-intent resection of primary and metastatic spinal chondrosarcoma over a 25-year period. Univariate and multivariate survival analyses were conducted with LRFS as primary endpoint and OS as secondary endpoint. LRFS and OS were modeled using the Kaplan-Meier method and assessed using Cox regression analysis. RESULTS: For 72 patients who underwent first resection, the median follow-up time was 5.1 years (95% CI 2.2-7.0). Thirty-three patients (45.8%) had en bloc resection, and 39 (54.2%) had piecemeal resection. Of the 68 patients for whom extent of resection was known, 44 patients had gross total resection (GTR) and 24 patients had subtotal resection. In survival analyses, both LRFS and OS showed statistically significant difference based on the extent of resection (p = 0.001; p = 0.04, respectively). However, only LRFS showed statistically significant difference when assessing the type of resection (p = 0.02). In addition, higher tumor grade and more invasive disease were associated with worse LRFS and OS rates. CONCLUSION: Although in our study en bloc and GTR were associated with improved survival, heterogenous and complex spinal presentations may limit total resection. Therefore, the surgical management should be tailored individually to ensure the best local control and maximum preservation of function. © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. DOI: 10.1007/s00586-022-07505-3