En Bloc Spondylectomy versus Separation Surgery for Spinal Metastases: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Neurosurgery
• Radiotherapy

Background:

• Spinal metastases present a significant challenge in cancer care.
• Two primary surgical interventions exist: en bloc spondylectomy and separation surgery with stereotactic body radiation therapy (SBRT).
• Comparative data on the effectiveness and safety of these techniques are limited.

Purpose of the Study:

• To compare the clinical outcomes of en bloc spondylectomy versus separation surgery with SBRT for treating spinal metastases.
• To evaluate differences in survival rates, progression, and complications between the two surgical approaches.

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, Scopus, and Web of Science up to January 2024.
• Meta-analysis of thirty-two observational studies involving 1149 patients (642 en bloc, 507 separation surgery with SBRT).
• Pooled odds ratios and survival analyses (Kaplan-Meier, Cox proportional hazards) were employed.

Main Results:

• En bloc spondylectomy resulted in significantly greater intraoperative blood loss (MD 883 mL, P < 0.001) and a trend towards higher postoperative infection risk (OR 1.44, P=0.05).
• No significant differences were observed in length of stay, progression-free survival, overall survival, or recurrence rates between the two groups (all P > 0.05).

Conclusions:

• En bloc spondylectomy and separation surgery with SBRT demonstrate comparable oncological outcomes for spinal metastases.
• En bloc techniques are associated with increased surgical complications.
• Further comparative effectiveness research is crucial to guide patient selection for these procedures.