Surgical treatment of large abdominally involved primary dumbbell tumor in the lumbar region.

Abstract

This was a retrospective clinical study. The aim of this study was to assess the efficacy of a combined anterior and posterior approach, or single-stage posterior extensive approach for resection of large abdominally involved dumbbell tumor in the lumbar region. Resection of the large spinal-retroperitoneal involved dumbbell tumor is particularly controversial and challenging because of unique exposure requirements. From June 2006 to October 2011, 18 consecutive patients suffering from large dumbbell tumors in the lumbar region were involved. In the initial 8 patients, a combined posterior and anterior surgical approach was applied. The remaining 10 patients were surgically treated with a single posterior extensive approach to excise both the intraspinal and intra-abdominal tumors. Reconstruction with bone or mesh grafts was also performed simultaneously in 3 of the 10 patients in this group. The perioperative period was uneventful for 7 of 8 patients who underwent combined surgery. However, 1 patient encountered right nephrectomy because of a ruptured renal vein and refractory bleeding during anterior tumor exposure. Histopathology revealed the presence of schwannoma (n=4), neurofibroma (n=3), and neuroblastoma (n=1). With the mean of 52 months of follow-up, metastasis occurred in 1 patient with neuroblastoma. In the 10 patients with only the posterior approach, histopathology demonstrated schwannoma (n=5), neurofibroma (n=3), small round cell mesenchymal tumor (n=1), and benign fibrous histiocytoma (n=1). No recurrence was detected at the mean follow-up of 24 months. The posterior extensive approach is safe and effective to remove the large abdominally involved dumbbell tumors, and also facilitates simultaneously reconstruction of the vertebral body, as compared with the combined posterior and anterior approach.