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Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study
Charlotte Dandurand1, Charles G Fisher1, Laurence D Rhines2
11Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
Objective:
Oncological resection of primary spine tumors is associated with lower recurrence rates. However, even in the most experienced hands, the execution of a meticulously drafted plan sometimes fails. The objectives of this study were to determine how successful surgical teams are at achieving planned surgical margins and how successful surgeons are in intraoperatively assessing tumor margins. The secondary objective was to identify factors associated with successful execution of planned resection.
Methods:
The Primary Tumor Research and Outcomes Network (PTRON) is a multicenter international prospective registry for the management of primary tumors of the spine. Using this registry, the authors compared 1) the planned surgical margin and 2) the intraoperative assessment of the margin by the surgeon with the postoperative assessment of the margin by the pathologist. Univariate analysis was used to assess whether factors such as histology, size, location, previous radiotherapy, and revision surgery were associated with successful execution of the planned margins.
Results:
Three hundred patients were included. The surgical plan was successfully achieved in 224 (74.7%) patients. The surgeon correctly assessed the intraoperative margins, as reported in the final assessment by the pathologist, in 239 (79.7%) patients. On univariate analysis, no factor had a statistically significant influence on successful achievement of planned margins.
Conclusions:
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 the expected success rate in order to optimize patient management and surgical decision-making.
Insights
Surgical teams achieve planned margins in 74.7% of primary spine tumor resections. Surgeons correctly assess margins intraoperatively in 79.7% of cases, with no factors significantly influencing success.
Area of Science:
- Neurosurgery
- Orthopedic Oncology
- Surgical Oncology
Background:
- Oncological resection of primary spine tumors aims to reduce recurrence rates.
- Achieving planned surgical margins is crucial for successful tumor removal.
- Despite meticulous planning, executing surgical margins can be challenging.
Purpose of the Study:
- To evaluate the success rate of achieving planned surgical margins in primary spine tumor resections.
- To assess the accuracy of intraoperative tumor margin assessment by surgeons.
- To identify factors influencing the successful execution of planned tumor resections.
Main Methods:
- Data from 300 patients in the Primary Tumor Research and Outcomes Network (PTRON) registry were analyzed.
- Planned surgical margins were compared with intraoperative and postoperative pathological assessments.
- Univariate analysis examined associations between factors (histology, size, location, radiotherapy, revision surgery) and margin achievement.
Main Results:
- Planned surgical margins were successfully achieved in 74.7% of patients (224/300).
- Surgeons accurately assessed intraoperative margins in 79.7% of cases (239/300).
- No analyzed factor demonstrated a statistically significant impact on achieving planned margins.
Conclusions:
- Approximately 75% of planned surgical margins are achieved in high-volume centers for primary spine tumors.
- Balancing intervention morbidity with success rates is vital for patient management and surgical decisions.
