Interdisciplinary Surgical Treatments and Long-Term Outcomes of Lumbar Spinal Tumors With Retroperitoneal Involvements: A Retrospective Case Series Study.

Shaohui He,Jianru Xiao,Yifeng Bi,Haifeng Wei,Dongyu Peng,Chen Ye

doi:10.3389/fonc.2021.720432

Abstract

PurposeSurgical treatments are technically challenging for lumbar spinal tumor (LST) with extensive retroperitoneal involvements. Our study aimed to report the experience and outcomes concerning interdisciplinary surgical collaborations in managing such LSTs.Patients and MethodsNine patients underwent interdisciplinary surgical treatments which were performed by specialists, namely, spinal, vascular, and urinary surgeries. Data on clinical characteristics were collected, and the Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association Score (JOAS) were used in the evaluation before and after surgery. The postoperative complications and the long-term outcomes were reported as well.ResultsThe interdisciplinary work included double J catheter indwelling (n = 9), nephrostomy (n = 5), replacement of the common iliac vein (n = 2), abdominal aorta repair (n = 3), and vital vessel repair (n = 8). The early-stage complications included complaints of moderate low back pain and slight implant shift (n = 1, 11.1%) and tardive ureterodialysis (n = 1, 11.1%). The 3- and 5-year disease-free survival rates were 76.2 ± 14.8 and 50.8 ± 23.0%, respectively, during the mean follow-up of 34.6 ± 17.9 months (range, 9.5–68.7). Besides this, more blood loss was associated with recurrent and metastatic tumor status (p = 0.043) and surgery time >5 h (p = 0.023). Remarkable pain relief and favorable quality of life were achieved based on the postoperative VAS (3.3 ± 0.9, p < 0.001) and JOAS (16.6 ± 0.5, p < 0.001).ConclusionsThe treatments of LSTs with wide-range retroperitoneal involvements require interdisciplinary surgical collaborations to lower the risks and improve the long-term outcomes. High-quality prospective cohort studies with large samples are warranted to establish general surgical protocols in managing LSTs with extensive retroperitoneal involvements.

Highlights

Lumbar spinal tumors (LSTs) are usually discovered with a considerably large size at initial diagnosis due to the retroperitoneal space ahead of the vertebra [1, 2]
Nine consecutive patients with LSTs were enrolled in our study, and the mean age was 42.3 ± 16.1 years old
The LSTs can be extremely large with significant tissue/organ involvements at initial diagnosis due to the great retroperitoneal space [1,2,3]

Summary

Introduction

Lumbar spinal tumors (LSTs) are usually discovered with a considerably large size at initial diagnosis due to the retroperitoneal space ahead of the vertebra [1, 2]. The tumor grows gradually in the retroperitoneum and compresses or infiltrates the adjacent normal tissue, including vital vascular structures, kidney, and ureter [2, 3]. The giant spinal tumors usually arise from the lumbosacral area with a relatively rare incidence [4,5,6]. The adjacent vertebral body and neurovascular structures are usually eroded by the invasive tumor biology. It is quite common that over 5 years are required to achieve a confirmed diagnosis after symptom onset with a lumbosacral mass [9]

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