DOI: 10.1097/brs.0000000000005816 ISSN: 0362-2436

Revision Negative Margin Resection Improves Prognosis After Enneking-Inappropriate Surgery in Primary Spinal Tumors

Ethan D. Schaffer, Thomas A. Wilcoxon, Amelia Osgood, Abigail T. Zhang, Thomas F. DeLaney, Peter G. Passias, Joseph Schwab, Francis J. Hornicek, Frank X. Pedlow, Daniel G. Tobert
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Study Design.

Retrospective cohort study of 42 patients with locally recurrent PST of the thoracic or lumbar spine after an EI resection performed by a referring institution. Patients were subsequently treated with gross total resection between 1995 and 2023. Outcome measures included local recurrence (LR), overall survival, mechanical complications, and functional outcomes.

Objective.

To report the outcomes of revision resection for PST after prior Enneking inappropriate (EI) resection and to compare these outcomes with published controls for index en bloc resection.

Summary of Background Data.

En bloc resection is the preferred treatment for primary spine tumors (PST). This recommendation is supported by improvements in local control and overall survival in prior studies. Outcomes in the revision resection setting remain unclear.

Methods.

Demographic, clinical, oncologic, and surgical variables were abstracted from medical records. Margin status was graded R0, R1, or R2 per pathology report. Overall survival and LR were estimated using the Kaplan Meier method. Between-group comparisons utilized Chi-square and Wilcoxon rank-sum testing.

Results.

Local recurrence occurred in 50.0% of patients. Five-year overall survival was 66.7% and to-date overall survival was 54.8%. Surgical margin was the strongest predictor of outcome: local recurrence occurred in 37.5% of R0 resections, 50% of R1 resections, and 100% of R2 resections ( P =0.20). R0 survival to-date was 21 of 29 patients (72.4%) and R1/R2 survival was 3 of 13 (23.1%) ( P =0.04). The perioperative complication rate was 28.6% and the revision surgery rate was 40.5%.

Conclusions.

Patients undergoing resection for PST following local recurrence after prior EI surgery experienced higher local recurrence rates and inferior survival compared with published cohorts for index en bloc resection. Yet, a negative margin revision resection improves oncologic prognosis. These data support early referral to a comprehensive spine tumor program as the standard of care for PST.

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