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Surgeon's perception of margins in spinal en bloc resection surgeries: how reliable is it?
Ran Lador1, Alessandro Gasbarrini2, Marco Gambarotti3
1Unit of Spine Surgery, Tel-Aviv Medical Center, 6 Weizman St., Tel-Aviv, 64239, Israel. ranilador@gmail.com.
Purpose And Background:
En bloc resections aim at surgically removing a tumor in a single, intact piece, fully encased by a continuous shell of healthy tissue-the "margin". Intraoperative continuous assessment of the plane of resection regarding the tumor's margins is paramount. The goal of this study was to evaluate the accuracy of experienced spinal tumor surgeons' perception of these margins.
Methods:
A retrospective analysis of a prospectively collected data of 1681 patients affected by spine tumors of whom 217 en bloc resections was performed. Surgeons' intraoperative assessment was compared to the histopathological assessment.
Results:
Most were primary-163 (42 benign and 121 malignant), metastases occurred in 54 cases. 'Wide' margins were obtained in 126 cases; 'marginal' in 60 cases, and 'intralesional' in 31 cases. Surgeons assessed clear margins in 109 cases and contaminated in 108 cases. When considering marginal margins as a contaminated resection, the surgeon's assessment of clear resection had a sensitivity of 76.89%, specificity of 86.81%, PPV and NPV (positive and negative predictive values) were 88.99 and 73.15%, respectively. Inter-observer agreement was 0.62. When considering marginal margins as a clear resection, the surgeon's assessment of clear resection had a sensitivity of 64.5%, specificity of 100%, PPV and NPV were 100 and 0%, respectively. Inter-observer agreement was 0.29.
Conclusion:
Surgeons are fairly accurate in their intraoperative assessment of clear margins achieved; however, this accuracy is not perfect and exploring ways to improve this intraoperative assessment is of major importance possibly impacting the outcome of the treatment.
Insights
Spinal tumor surgeons are fairly accurate in assessing surgical margins during en bloc resections. However, improving this intraoperative assessment is crucial for optimizing patient treatment outcomes.
Area of Science:
- Spine surgery
- Surgical oncology
- Tumor resection
Background:
- En bloc resection involves surgically removing tumors with a surrounding margin of healthy tissue.
- Intraoperative assessment of resection margins is critical for successful tumor removal.
- Accurate margin assessment impacts treatment efficacy and patient outcomes in spinal tumor surgery.
Purpose of the Study:
- To evaluate the accuracy of experienced spinal tumor surgeons' intraoperative perception of resection margins.
- To compare surgeons' real-time assessment with definitive histopathological findings.
Main Methods:
- Retrospective analysis of prospectively collected data from 1681 spinal tumor patients.
- Included 217 en bloc resections, comparing surgeon's intraoperative margin assessment with histopathological results.
- Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and inter-observer agreement.
Main Results:
- Surgeons' assessment showed a sensitivity of 76.89% and specificity of 86.81% when marginal margins were considered contaminated.
- Inter-observer agreement was 0.62 when marginal margins were considered contaminated.
- When marginal margins were considered clear, sensitivity dropped to 64.5% with 100% specificity, and inter-observer agreement decreased to 0.29.
Conclusions:
- Experienced spinal tumor surgeons demonstrate fair accuracy in assessing clear margins during en bloc resections.
- The accuracy of intraoperative margin assessment is not perfect, highlighting the need for improvement.
- Enhancing intraoperative margin assessment techniques may significantly improve treatment outcomes for spinal tumors.
