ANTERIOR APPROACHES TO THE THORACIC SPINE IN PATIENTS WITH CANCER - INDICATIONS AND RESULTS

Background. Multidisciplinary surgical teams enable an aggressive appr oach to tumors involving the thoracic spine. Methods. From February 19 94 to July 1996, 61 patients underwent anterior resections of thoracic spine tumors. Their median age was 56 years. The indications for oper ation were curative in intent in 7 of 61 and palliative in 54 of 61 (t o relieve intractable metastatic bone pain with neurologic compromise [n = 38] and pain alone [n = 16]). Sixteen patients came to our instit ution unable to ambulate with impending paraplegia. Results. Anterior approaches included combined left side of the neck and median sternoto my for lesions involving vertebrae T-1 through T-3 (n = 9), posterolat eral thoracotomy for T-3 through T-10 (n = 39), and thoracoabdominal a pproach at T-11 and T-12 (n = 13). Median hospital stay was 9.0 days ( range, 4 to 57 days). Complications occurred in 18 of 61 (29.5%). In 5 5 of 61 (90%), pain was significantly improved after the operation. Tw elve of the 16 patients who initially presented in wheelchairs regaine d ambulatory function. There were five perioperative deaths (8.2%). Th e 1-year cumulative survival for the entire group was 60%. Conclusions . An aggressive surgical approach in cancer patients with locally adva nced or metastatic disease in the thoracic spine was associated with a cceptable morbidity and mortality. There was significant improvement i n their quality of life by control of intractable pain in 90% and reco very of ambulatory function in 75% of patients who presented with crit ical spinal cord compromise. (C) 1997 by The Society of Thoracic Surge ons.