110. Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study

Abstract

<h3>BACKGROUND CONTEXT</h3> Oncologic resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, executing a meticulously drafted plan sometimes fails. <h3>PURPOSE</h3> The goal of this study was to utilize prospective multicenter data to determine how successful experienced surgical teams are at achieving planned surgical margins and how successful surgeons are in assessing tumor margins intraoperatively. The secondary objective was to identify factors that are associated with successful execution of the planned margins. <h3>STUDY DESIGN/SETTING</h3> This study was part of a multicenter international prospective registry for the management and outcomes of primary tumors of the spine called Primary Tumor Research and Outcomes Network (PTRON, ClinicalTrials.gov: NCT02790983). PTRON was designed and led by the AO Spine Knowledge Forum Tumor and has established an international network of 16 spine oncology centers from North America, Europe, and Asia that are dedicated to prospective research of patients diagnosed with a primary tumor of the spine. <h3>OUTCOME MEASURES</h3> Using this registry, we compared (1) planned surgical margin and (2) intraoperative assessment of the margin by the surgeon to the postoperative assessment of the margin by the pathologist. Planned and intraoperative margin assessments by the surgeon were assessed and recorded in the PTRON database in five categories: (1) intralesional; (2) intralesional with planned focal transgression; (3) marginal; (4) wide with marginal at dura, and (5) wide. The pathologist's assessment was documented in four categories for overall margin, at soft tissue, at bone, and at dura: (1) intralesional; (2) intralesional with planned focal transgression; (3) marginal; and (4) wide. The primary endpoints of this analysis were to compare (1) the planned surgical margin and (2) intraoperative assessment of the margin by the surgeon to the postoperative assessment of the margin by the pathologist. For the first endpoint, success was defined as achievement of planned surgical margins or better as confirmed by pathologist assessment. For the second endpoint, success was defined by appropriate intraoperative assessment of the margin by the surgeon when compared to histologic assessment. <h3>METHODS</h3> Univariate analyses were used to assess factors associated with successful execution of the planned resection. <h3>RESULTS</h3> A total of 300 patients from 16 centers located in North America, Europe and Asia were included for analysis. Median age was 46.0 years (IQR 27.0 – 61.5). The majority of patients were male (63.0%). Successful achievement of planned margins was attained in 224 patients (74.7%). Overall, marginal or wide margins were attained in 261 patients (87.0%). Surgeon's perception of the margins achieved intraoperatively was correctly determined in 239 patients (79.7%) compared to pathologist assessment. Margins identified as marginal or wide were adequately evaluated intraoperatively as such in 261 patients (87.0%). On univariate analysis, no factors had a statistically significant association with the achievement of successful margins. <h3>Conclusions</h3> In high volume cancer centers around the world, planned surgical margins can be achieved in approximately 75% of cases. The morbidity of the proposed intervention must be balanced with expected success rates in order to optimize patient management and surgical decision-making. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.