Late local recurrence, at 19 and 17years, of sacral chordoma treated by en bloc resection

OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

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Long-Term Outcomes of High-Dose Single-Fraction Radiosurgery for Chordomas of the Spine and Sacrum

Neurosurgery ◽

10.1093/neuros/nyz310_177 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Jenny Jin ◽

John Berry-Candelabra ◽

Y Josh Yamada ◽

Daniel Higginson ◽

Adam Schmitt ◽

...

Keyword(s):

Local Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

High Dose ◽

En Bloc ◽

Intralesional Resection ◽

Single Fraction ◽

Mobile Spine ◽

Symptom Response

Abstract INTRODUCTION To evaluate outcomes of patients with primary chordomas treated with spine stereotactic radiosurgery (SRS) alone or in combination with surgery, drawing from a single-institution database to elucidate treatment options associated with durable radiographic control of these conventionally radioresistant tumors. Chordomas result in significant morbidity, with a high rate of local recurrence and potential for metastases. SRS as a primary treatment could save patients from extensive surgery. Spine SRS outcomes support exploration of its role in the durable control of these conventionally radioresistant tumors. METHODS Clinical records were reviewed for outcomes of patients with primary chordoma of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to extent of surgery. RESULTS In total, 35 patients with de novo chordoma of the mobile spine (49%) and sacrum (51%) received SRS with a median post-SRS follow-up of 38.8 mo (range: 2.0-122.9). The median PTV dose was 24Gy (range: 18–24Gy). Overall, 12 patients (33%) underwent definitive SRS and 23 patients (66%) underwent surgery followed by adjuvant SRS. Surgical strategies included separation surgery prior to SRS, curettage/intralesional resection, and en bloc resection in 7, 6, and 10 patients, respectively. The 3- and 5-yr LRFS rates were 86.2% and 80.5% respectively. Among 32 patients receiving 24 Gy (91%), the 3- and 5-yr LRFS were 96.3% and 89.9%. The 3- and 5-yr OS rates were 90.0% and 84.3%. The symptom response rate to treatment was 88% for pain and radiculopathy. Extent or type of surgery was not associated with LRFS, OS, or symptom response rates (P > .05), but en bloc resection was associated with higher CTCAE v. 5.0 surgical toxicity compared to epidural decompression and curettage/intralesional resection (P = .03). The long-term = grade 2 SRS toxicity rate was 31%, including 17% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, fracture, and secondary malignancy. CONCLUSION High-dose spine SRS offers the chance of durable radiographic control and effective symptom relief with acceptable toxicity for primary chordomas as either definitive or adjuvant therapy.

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The relationship between local recurrence and positive lateral margin after en bloc resection of colorectal neoplasm

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2018.1547419 ◽

2018 ◽

Vol 53 (12) ◽

pp. 1541-1546 ◽

Cited By ~ 2

Author(s):

Jae Yun Kim ◽

Su Jung Han ◽

Yunho Jung ◽

Young Sin Cho ◽

Il-Kwun Chung ◽

...

Keyword(s):

Local Recurrence ◽

Colorectal Neoplasm ◽

En Bloc Resection ◽

Bloc Resection ◽

Lateral Margin ◽

En Bloc ◽

The Relationship

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Sa1638 Risk Factors for Local Recurrence After En Bloc Resection of Endoscopic Submucosal Dissection for the Early Gastric Cancer Treatment

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.373 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB231

Author(s):

Eunsoo Kim ◽

Kwangbum Cho ◽

Kyung Sik Park

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Early Gastric Cancer ◽

Local Recurrence ◽

Endoscopic Submucosal Dissection ◽

Cancer Treatment ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Gastric Cancer Treatment

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P-O07 Endoscopic submucosal dissection for giant esophageal lipomatous tumors

British Journal of Surgery ◽

10.1093/bjs/znab430.117 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Zi-Han Geng ◽

Xiao-Yue Xu ◽

Yan Yan Zhu ◽

Wei Su ◽

Quan-Lin Li ◽

...

Keyword(s):

Local Recurrence ◽

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

Maximum Diameter ◽

En Bloc ◽

Submucosal Dissection ◽

Gastric Submucosal Tumors ◽

Average Maximum ◽

Lipomatous Tumors

Abstract Background Thoracotomy is the foremost choice of giant esophageal lipomatous tumors in previous studies, but it is highly traumatic and possibly diminishes the quality of patients’ life. To minimize such impacts, a minimally invasive method without loss of curability is desirable for giant lipomatous tumors of the esophagus. With recent progress in endoscopic techniques and devices, endoscopic submucosal dissection (ESD) has been successfully used to remove esophageal or gastric submucosal tumors (SMTs). Methods Objective: To evaluate the clinical impact of ESD for giant esophageal lipomatous tumors. Design: Single-center, retrospective study. Setting: Academic medical center. Patients: Six patients with six giant lipomatous tumors of the esophagus between February 2013 and December 2020. Interventions: ESD. Main Outcome Measurements: Procedure duration, en bloc resection rate, complications, local recurrence, and distant metastases. Results Endoscopic en bloc resections of esophageal lipomatous tumors were successfully performed in all patients, with a mean duration of 56.5 ± 26.0 min. All en bloc resection lesions showed both lateral and deep tumor-free margins. The average maximum diameter of the esophageal lipomatous tumors was 171.7 ± 66.2 mm. No complications such as bleeding and perforations happened during hospitalization with 4.0 ± 1.6 days. Besides, local recurrence and distant metastasis have not occurred during the follow-up period. Conclusions ESD was a safe and effective way to dissect giant lipomatous tumors of the esophagus thoroughly.

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Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-025803 ◽

2019 ◽

Vol 9 (12) ◽

pp. e025803 ◽

Cited By ~ 1

Author(s):

Maogen Tao ◽

Xiaobo Zhou ◽

Meiqing Hu ◽

Jun Pan

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Local Recurrence ◽

Curative Resection ◽

Meta Analysis ◽

Operation Time ◽

En Bloc Resection ◽

Bloc Resection ◽

Complete Resection ◽

En Bloc

ObjectivesTo investigate the treatment effects of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC).DesignMeta-analysis.MethodsWe systematically searched three electronic databases, including PubMed, EmBase and the Cochrane library for studies published with inception to January 2018. The eligible studies should be evaluated for the efficacy and safety of ESD versus EMR for patients with EGC. The summary ORs and standard mean differences (SMDs) with 95% CIs were employed as effect estimates. Sensitivity analyses were conducted to evaluate the impact of single study on overall analysis. Subgroup analyses were performed for investigated outcomes to evaluate the treatment effects of ESD versus EMR for patients with EGC with specific subsets.ResultsEighteen studies, with a total of 6723 patients with EGC, were included in final analysis. The summary ORs indicated that patients with EGC who received ESD were associated with an increased incidence of en bloc resection (OR: 9.00; 95% CI: 6.66 to 12.17; p<0.001), complete resection (OR: 8.43; 95% CI: 5.04 to 14.09; p<0.001) and curative resection (OR: 2.92; 95% CI: 1.85 to 4.61; p<0.001) when compared with EMR. Furthermore, ESD was associated with lower risk of local recurrence (OR: 0.18; 95% CI: 0.09 to 0.34; p<0.001). In addition, there was no significant difference between ESD and EMR for the risk of bleeding (OR: 1.26; 95% CI: 0.88 to 1.80; p=0.203). Though, ESD was correlated with greater risk of perforation (OR: 2.55; 95% CI: 1.48 to 4.39; p=0.001), and longer operation time (SMD: 1.12; 95% CI: 0.13 to 2.10; p=0.026) as compared with EMR. Additionally, several different features observed in included studies and patients could bias the effectiveness of ESD versus EMR in patients with EGC.ConclusionsESD is superior than EMR for en bloc resection, complete resection, curative resection and local recurrence, while it increased perforation risk and longer operation time.

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The long term surgical outcome of spinal giant cell tumor.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e22510 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e22510-e22510

Author(s):

Joonho Yoon ◽

Chun Kee Chung ◽

Sunho Lee ◽

Chiheon Kim

Keyword(s):

Local Recurrence ◽

En Bloc Resection ◽

Bloc Resection ◽

Rank Test ◽

Radical Excision ◽

Total Removal ◽

En Bloc ◽

Additional Surgery ◽

Significant Difference ◽

Mobile Spine

e22510 Background: GCT is a benign and locally aggressive tumor that occur infrequently in the mobile spine. The radical excision is generally agreed for treatment of GCTs. Methods: We performed retrospective analysis of 20 GCTs in the mobile spine from 2005 to 2013. Verteberal involvement was classified with Weinstein-Boriani-Biagini grading system. Surgery types were classified into 3 groups; partial excision, gross total removal (GTR), and en-bloc resection. We analysis by GTR versus non-GTR group, and enbloc versus non-enbloc group in GTR group. The log rank test was used for comparison of factors, and a P value of less than 0.05 was deemed significant. Results: After first surgery of the 20 patients, 17 additional surgery performed for 10 (50%) patients. There were 7 (35%) local recurrences and 3 (15%) distant metastasis. The time to recurrence or progression of tumor ranged from 5 months to 39 months. Two (10%) patients had additional surgery for instrument failure. One (5%) patient died from the complication of the surgery. The follow up duration ranged from 24 months to 141 months. The local recurrence was associated with partial resection (P < 0.01) and history of recurrence (P = 0.39). There was no significant difference between non-en bloc GTR and en bloc GTR in local recurrence (p = 0.101). Conclusions: Gross total resection should be considered for GCTs of the mobile spine. The choice of en bloc resection must be balanced with risks of the procedure. En bloc resection or radical excision could be challenging in many cases. In that cases, the gross total removal by intralesional resection is considerable for local control.

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Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma

Journal of Neurosurgery Spine ◽

10.3171/2014.1.spine12652 ◽

2014 ◽

Vol 20 (4) ◽

pp. 421-429 ◽

Cited By ~ 1

Author(s):

Rajiv Saigal ◽

Daniel C. Lu ◽

Donna Y. Deng ◽

Dean Chou

Keyword(s):

Sexual Function ◽

Functional Outcome ◽

Nerve Root ◽

En Bloc Resection ◽

Bloc Resection ◽

Nerve Roots ◽

En Bloc ◽

Risk Of Recurrence ◽

Nerve Preservation ◽

Sacral Chordoma

Chordomas of the sacrum require en bloc resection to reduce the risk of recurrence, but this may sacrifice nerves vital to bladder, bowel, and sexual function. High, mid-, and low sacral amputations have been previously classified based on nerve root sacrifice, not bony amputation. Sacrifice of the S-2 nerves or those above results in a high sacral amputation, but preserving the S-2 nerves converts it into a midsacral amputation. Preservation of the S-2 nerves has been shown to improve functional outcome, despite the bony osteotomy being unchanged. Thus, keeping the same bony amputation while preserving the S-2 nerve roots may allow for improved functional outcome while still achieving the same goal of oncological resection. Preservation of the S-2 nerves may be particularly difficult during amputation at the S-2 pedicle or above, and the authors describe their technique for preserving the S-2 nerves during partial sacrectomy at or just above the S-2 pedicle. Four cases of sacral chordoma resections are presented to illustrate the technique.

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