Intralesional resection of primary and metastatic sarcoma involving the spine: Outcome analysis of 59 patients

OBJECTIVE: Surgery plays an important role in achieving local tumor control and cure for primary and metastatic tumors of the spine. As has been estab lished with regard to sarcomas at extraspinal sites, these goals may best b e achieved by en bloc resection with negative histological margins. Unfortu nately, sarcomas of the spine often present with tumor patterns that are am enable only to intralesional resection, if neurological preservation is a p riority. This study is a retrospective analysis of the long-term outcomes o f patients who had operations for sarcomas of the spine using modern surgic al approaches, intralesional resections, and spinal instrumentation. METHODS: Between 1985 and 1997, 59 patients had spinal operations for sarco ma involving the extrasacral spine. Data regarding tumor histology, grade, surgical indications, patterns of spinal tumor involvement, and neurologica l and functional outcomes were reviewed at presentation and at tumor recurr ence. RESULTS: Thirty-five patients underwent a single operation, and 24 patients required reoperation for locally recurrent tumors. At presentation, only n ine patients (15%) had tumors that were amenable to marginal or wide resect ions. Functional outcomes after initial spinal surgery and after operations performed at first tumor recurrence showed that 95% of patients had mainta ined or regained ambulation. Intradural extension of tumor was seen in 5 of 12 patients who had three or more operations for locally recurrent disease . The median survival from first spine operation was 18 months, and the med ian event-free interval between the first and second spine operations was 1 3 months. CONCLUSION: Surgery for sarcoma of the spine is useful for maintaining or i mproving neurological and functional outcomes, but local tumor recurrences are common. Because of the anatomy of the tumor at presentation and concern for neurological preservation, few patients are candidates for marginal or wide resections.