A multidisciplinary surgical approach to superior sulcus tumors with vertebral invasion

Background. Vertebral body invasion by superior sulcus tumor has traditiona lly been considered a contraindication to surgical resection. Attempts at d efinitive radiation or chemoradiation have not been successful. Recent adva nces in spinal instrumentation have allowed more complete resection of vert ebral body tumors. We, therefore, reviewed our recent experience with verte bral resection of superior sulcus tumors. Methods. All patients (n = 17) undergoing resection of superior sulcus tumo rs with T4 involvement of the vertebrae from October 18, 1990 to September 21, 1998 at the University of Texas M.D. Anderson Cancer Center (MDACC) wer e evaluated. Their clinical and pathologic data were reviewed and analyzed for short- and longterm outcomes. Results. Total vertebrectomy was performed in 7 patients (42%), partial ver tebrectomy in 7 (42%), and 3 (18%) underwent neural foramina or transverse process resection. The median hospital stay was 11 days. Postoperative comp lications occurred in 7 patients (42%) and included pneumonia (6, 36%), arr hythmia (2, 12%), cerebrospinal fluid leak (2, 12%), wound breakdown (1, 6% ), and reoperation for bleeding (1, 6%). Sixteen out of 17 patients receive d preoperative or postoperative radiation therapy. No perioperative mortali ty occurred. All patients remained ambulatory after spinal reconstruction. Overall actuarial survival at 2 years was 54%, with 11 patients still alive 2 to 50 months after resection. Locoregional tumor recurrence was noted in all 6 patients who had positive surgical margins, as opposed to 1 out of 1 1 patients (9%) with negative margins (p < 0.006). Additionally, the 2-year actuarial survival of patients with negative microscopic margins was 80% v ersus 0% for positive margins (p < 0.0006). Conclusions. An aggressive multidisciplinary approach to superior sulcus tu mors with vertebral invasion can lead to long-term survival with acceptable morbidity if negative margins can be obtained. Vertebral body invasion sho uld no longer be considered a contraindication for resection of superior su lcus tumors. (C) 1999 by The Society of Thoracic Surgeons.