Mini open tumor resection and percutaneous instrumentation for T11 renal cell carcinoma metastasis

Abstract

Neural decompression and stabilization belong to the standards of oncologic management of metastatic vertebral lesions, which are at risk of spinal cord compression. Quality of life, tumor associated pain, pathologic fractures and the neurologic status may be improved by surgical treatment [1]. The revised Tokuhashi score [2] represents a common tool, which enables predicting prognosis on a multidisciplinary basis and to decide if conservative treatment or palliative surgery would be adequate, depending on the patient’s pathology and comorbidities. Minimally invasive surgery may enlarge the possibilities of palliative procedures. Cementoplasty has a stabilizing effect at the level of the vertebral body and reduces pain efficiently [3]. This technique can be combined with decompression of the lumbar spine, if facet joints and pedicles remain intact. Minimally invasive transpedicular tumor resection through a tubular retractor, combined with percutaneous instrumentation, has been recently described for unstable compressive lesions [4]. Additionally, metastases of well-vascularized primary tumors, such as renal cell carcinoma, present an intraoperative risk of hemorrhage and require a preoperative transarterial embolization [5, 6]. A limited open approach, focused on the tumor area, may further reduce intraoperative bleeding and operating time, which represents a theoretical advantage with regard to the patient’s morbidity.