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. 2024 Mar;16(3):613-619.
doi: 10.1111/os.13999. Epub 2024 Jan 29.

Comparison of En Bloc Resection and Intralesional Excision for Re-resection of Giant Cell Tumors of the Spine

Hua Zhou  1   2   3 , Yanchao Tang  1   2   3 , Panpan Hu  1   2   3 , Shuheng Zhai  1   2   3 , Xiaoguang Liu  1   2   3 , Zhongjun Liu  1   2   3 , Feng Wei  1   2   3
Affiliations

Comparison of En Bloc Resection and Intralesional Excision for Re-resection of Giant Cell Tumors of the Spine

Hua Zhou et al. Orthop Surg. 2024 Mar.

Abstract

Objective: Re-resection of spinal giant cell tumors is an exceedingly difficult procedure. Moreover, the prognosis of patients with en bloc resection or intralesional excision for re-resection has rarely been reported. This study aimed to compare the prognostic value of en bloc resection with that of intralesional excision in patients undergoing re-resection for giant cell tumors of the spine.

Methods: This retrospective analysis evaluated patients who underwent revision surgeries for relapse of giant cell tumors of the spine at our center between January 2005 and January 2021. Local progression-free survival represents the duration between en bloc resection or intralesional excision and tumor recurrence. Neurological recovery, survival rates, local control, and complications were evaluated. The Kaplan-Meier estimator was used for survival analysis.

Results: A total of 22 patients (nine men and 13 women) with a mean age of 34.1 (range 19-63) years were included. Significant statistical differences were found in the local tumor recurrence rate between patients treated with en bloc resection and those treated with intralesional excision (p < 0.05). The 5- and 10-year local progression-free survival rates were both 90% in the en bloc resection group, while in the intralesional excision group, the 5-year local progression-free survival rate was 80% with a 10-year rate of 45.7%. The en bloc resection group had a lower local tumor recurrence rate than that of the intralesional excision group (p < 0.05), but the former had a higher rate of complications (p = 0.015).

Conclusions: This study revealed a low local recurrence rate in patients who underwent en bloc resection for giant cell tumors, while the perioperative complication rate was high.

Keywords: En Bloc Resection; Giant Cell Tumor; Intralesional Excision; Radiotherapy; Recurrence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
L1–L3 giant cell tumor in a 26‐year‐old man. A resection biopsy performed 6 months prior at a local hospital resulted in incomplete resection. Anteroposterior and lateral lumbar spine radiographs (A, B) performed at a local hospital after the resection biopsy are shown. Coronal CT (C) and transverse CT (D) show the bone destruction of the tumor. Sagittal MRI (E) and transverse MRI (F) show paravertebral soft tissue tumors. CT, computed tomography; MRI, magnetic resonance imaging.
FIGURE 2
FIGURE 2
Revision surgery of a representative patient at our center. The patient was transferred to our hospital and underwent en bloc resection to achieve total gross tumor resection. CT imaging (A, B) of the surgically resected specimen shows en bloc resection of the tumor. The patient was followed up for 2 years after the procedure at our center. The anteroposterior and lateral radiographs (C, D) show no instrumentation failure. Coronal CT (E) and sagittal CT (F) show no 3D‐printed prosthesis subsidence. MRI (G) shows no tumor recurrence, and most cerebrospinal fluid leakage has been absorbed. CT, computed tomography; MRI, magnetic resonance imaging.
FIGURE 3
FIGURE 3
Kaplan–Meier analysis of cumulative local progression‐free survival of patients. The local progression‐free survival of patients undergoing total en bloc spondylectomy with blue line is higher than that of patients undergoing extracapsular intralesional excision with green line.
See this image and copyright information in PMC

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