Outcomes of Surgery for Sacral Chordoma and Impact of Complications: A Report of 50 Consecutive Patients With Long-Term Follow-Up

Study Design: Retrospective case series. Objective: To determine predictive factors of overall survival (OS) and local recurrence (LR), report complications, and assess the impact of complications on survival, recurrence, and function in patients undergoing en bloc resection of sacral chordoma. Methods: This retrospective case series was obtained from a prospective database (1995-2016). All patients underwent en bloc resection of sacral chordoma. Demographic, perioperative, and complication data were collected. Outcomes included: overall survival(OS), local recurrence(LR), and complications. Survival analysis with multivariable cox regression was performed. Results: Among 50 patients, median follow-up was 5.3 years (range = 1.3-17.2). The majority (82%) underwent a negative margin resection. Survival: 17 patients died (34%) with a median OS of 10.0 years (range = 1.3-17.2). Multivariable cox regression revealed that a negative margin resection was not significantly associated with improved survival (HR = 3.35, 95%CI 0.87-12.80, P = .078). Recurrence: 20 patients (40%) experienced LR with a median time of 6.2 years (range = 0-16.9). Multivariable cox regression revealed that a negative margin resection was associated with a significant decreased risk of LR (HR = 4.96, 95%CI 1.84-13.34, P = 0.002,). A 62% overall complication rate was seen (42% major), with 26% reoperation rate. Of the reoperations, 54% were delayed (>6 weeks after the index surgery). Multivariable cox regression demonstrated that neither major complication nor reoperation significantly impacted OS (HR = 0.62, 95%CI 0.22-1.79, P = 0.380), LR (HR = 1.28, 95%CI 0.49-3.36, P = 0.611), or functional outcomes (OR = 2.94, 95%CI 0.25-34.8, P = 0.393). Conclusions: Negative margin resection was associated with decreased LR. Neither major complication nor reoperation significantly impacted OS, LR, or functional outcome. Though additional studies are needed, it appears that despite the morbidity associated with sacral chordoma resection, the long-term clinical outcomes are favorable.

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Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

Endoscopy International Open ◽

10.1055/a-1321-1271 ◽

2021 ◽

Vol 09 (02) ◽

pp. E258-E262

Author(s):

Christian Suchy ◽

Moritz Berger ◽

Ingo Steinbrück ◽

Tsuneo Oyama ◽

Naohisa Yahagi ◽

...

Keyword(s):

Case Series ◽

En Bloc Resection ◽

Bloc Resection ◽

Published Data ◽

Low Grade ◽

Recurrence Rates ◽

En Bloc ◽

Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

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Midsacral Amputation for En Bloc Resection of Chordoma

Operative Neurosurgery ◽

10.1227/01.neu.0000365799.21610.c4 ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-41-ons-44 ◽

Cited By ~ 3

Author(s):

Ganesh Rao ◽

George J. Chang ◽

Ian Suk ◽

Ziya Gokaslan ◽

Laurence D. Rhines

Keyword(s):

En Bloc Resection ◽

Bloc Resection ◽

Surgical Margins ◽

En Bloc ◽

Sacral Chordoma ◽

Sacral Tumor ◽

Tumors Of The Sacrum ◽

Successful Removal ◽

Sacral Tumors

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

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Faculty Opinions recommendation of Surgical Treatment of Sacral Chordoma: En Bloc Resection with Negative Margins is a Determinant of the Long-Term Outcome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734030623.793576248 ◽

2020 ◽

Author(s):

Carlos Bagley

Keyword(s):

Surgical Treatment ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Term Outcome ◽

Long Term Outcome ◽

Sacral Chordoma

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Long-Term Outcomes of En Bloc Resection of Non-Small Cell Lung Cancer Invading the Thoracic Inlet and Spine

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.04.100 ◽

2011 ◽

Vol 92 (3) ◽

pp. 1024-1030 ◽

Cited By ~ 20

Author(s):

Elie Fadel ◽

Gilles Missenard ◽

Charles Court ◽

Olaf Mercier ◽

Sacha Mussot ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

En Bloc Resection ◽

Bloc Resection ◽

Small Cell ◽

Small Cell Lung ◽

Long Term Outcomes ◽

En Bloc ◽

Thoracic Inlet

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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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High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

Endoscopy International Open ◽

10.1055/a-0965-8531 ◽

2019 ◽

Vol 07 (09) ◽

pp. E1166-E1174 ◽

Cited By ~ 9

Author(s):

Jérémie Jacques ◽

Aurélie Charissoux ◽

Pierre Bordillon ◽

Romain Legros ◽

Jérôme Rivory ◽

...

Keyword(s):

Case Series ◽

Rubber Band ◽

En Bloc Resection ◽

Bloc Resection ◽

Point Of View ◽

University Hospital ◽

Control Group ◽

R0 Resection ◽

Resection Rate ◽

En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

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Endoscopic resection of low grade, subglottic chondrosarcoma

The Journal of Laryngology & Otology ◽

10.1017/s0022215109990284 ◽

2009 ◽

Vol 123 (12) ◽

pp. 1364-1366 ◽

Cited By ~ 5

Author(s):

Y Oestreicher-Kedem ◽

T G Dray ◽

E J Damrose

Keyword(s):

Endoscopic Resection ◽

Cricoid Cartilage ◽

Voice Quality ◽

En Bloc Resection ◽

Bloc Resection ◽

Low Grade ◽

Retrospective Case ◽

En Bloc ◽

Extensive Resection ◽

Airway Patency

AbstractIntroduction:This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.Method:Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.Results:Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.Summary:Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

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Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.1 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 1-1

Author(s):

T. Iizuka ◽

D. Kikuchi ◽

S. Hoteya

Keyword(s):

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Additional Treatment ◽

En Bloc ◽

Carcinoma Of The Esophagus ◽

Secondary Hemorrhage ◽

Long Term Follow Up

1 Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma. Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months. Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%. Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus. No significant financial relationships to disclose.

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