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- Title
Adverse Events Profile in EN Bloc Resection and Surgery for Primary Bone Tumor.
- Authors
Srinivas, Shreya; Fisher, Charles; Boyd, Michael; Paquette, Scott; Kwon, Brian; Ailon, Tamir; Morin, Raphaele Charest; Dvorak, Marcel; Street, John; Dea, Nicolas
- Abstract
Introduction: En bloc resection is uncommonly performed in the spine. Available evidence on complications after oncological surgery is of very low quality, often from small retrospective series with inconsistencies in adverse events (AE) reporting. The purpose of this study is to determine the AE profile in the population of patients undergoing en bloc resection for spinal metastases or surgery for primary bone tumor of the spine. Materials and Methods: This is a prospective cohort study in a single quaternary care referral center. All consecutive patients who underwent surgery for metastases with a curative intent or surgical excision of a primary tumor of the spine between January 1, 2009 to July 31, 2017 were included. AE were collected on a standardized form (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly-dedicated morbidity and mortality rounds. Data collected included patient demographics, primary tumor histology, neurological status, surgical intervention details, marginal status, Enneking appropriateness and all AEs (perioperative and post-operative) Results: A total of 56 patients (34 males, 22females average age 57.6 years) met the inclusion criteria and had complete data. Of these, 51 patients had a primary bone tumor and 5 patients had a metastatic lesion (enbloc resection). In the primary tumors, surgical resection margins were wide or marginal in 40, intralesional in 8 and indeterminate in 3 patients. There was at least 1 AE observed in 38 patients (68%) and there were no deaths seen. Of these 11 patients (20%) had Intraoperative AEs and common surgical complications seen were dural tear (20%), visceral or neuro vascular injury (18%), massive blood loss in excess of 2 L (14%), and implant/hardware malposition(12%). Predominantly AE was seen in the post- operative period in 33 patients (59%) and usually due to either a systemic infection (UTI/pneumonia) in 41% or a cardiac event (39%). Incidence of thromboembolic events (DVT/PE) was 12%. Implant failure or non-union was less common (5%) and neurological deterioration was seen only in 4 patients.(7%). AE occurred in patients who underwent wide/marginal resection (n = 35; 87.5%) rather than intralesional resection (n = 4; 50%). There was also significant wound related complication seen in 34% of the patients. This was more commonly seen in those who had surgical resection performed for lesions around the sacrum (88%) as compared to tumour location in the rest of the spine (7%). Conclusion: Surgery for primary bone tumors is associated with high incidence of AE. This should be of significant consideration when counselling these patients for surgical intervention and should be confronted to the curative intent of the procedure. A better understanding of this AE profile will benefit the surgeon and oncologist in developing preventative strategies in this patient cohort.
- Publication
Global Spine Journal, 2018, Vol 8, p150S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030