Multi-Level En Bloc Resection as a Preferred Salvage Therapy for Recurrent Thoracolumbar Chondrosarcoma: A Comparative Study with Piecemeal Resection.

STUDY DESIGN: A retrospective analysis was performed. OBJECTIVE: Evaluate the feasibility and effectiveness of multi-level en bloc resection vs. piecemeal resection for recurrent thoracolumbar chondrosarcoma (CHS). SUMMARY OF BACKGROUND DATA: Multi-level en bloc resection for recurrent thoracolumbar CHS is rarely performed. METHODS: Included in this retrospective study were 27 patients with recurrent thoracolumbar CHS who received either multi-level en bloc resection or piecemeal resection as a salvage revision procedure in our center between 2010 and 2018. Relevant data between the two methods was compared. Relapse-free survival (RFS) and overall survival (OS) were analyzed by log-rank analysis. RESULTS: Our series comprised 16 males and 11 females with a mean age of 40.7 years. Multi-level en bloc resection was performed in 17 patients, and piecemeal resection in 10 patients. Of the 17 patients receiving multi-level en bloc resection, 5 patients experienced recurrence, of whom 3 died, while in the 10 patients receiving piecemeal resection, 7 experienced recurrence and all of them died, showing a significant difference between the two groups (p = 0.04 for recurrence, p = 0.007 for death). Complications occurred more frequently in the patients receiving multi-level en bloc resection (p = 0.04), but RFS and OS were prolonged significantly in this group of patients as compared with piecemeal resection group (56.8 +/- 9.7 vs. 17.2 +/- 4.2, p = 0.016; 67.3 +/- 8.4 vs. 21.4 +/- 3.5, p = 0.002). CONCLUSIONS: Multi-level en bloc resection as a salvage therapy for recurrent thoracolumbar CHS is technically challenging with high risk of complications, but it can significantly prolong RFS and OS of such patients as compared with piecemeal resection. LEVEL OF EVIDENCE: 4.