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.