Efficacy and safety of en-bloc resection versus debulking for spinal tumor: a systematic review and meta-analysis

IF 2.5 3区医学 Q3 ONCOLOGY

World Journal of Surgical Oncology Pub Date : 2024-08-03 DOI:10.1186/s12957-024-03494-3

Kai Zhang, Qingzhong Zhou, Li Da, Ge Zhang

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Abstract

This systematic review and meta-analysis aimed to consolidate the existing evidence regarding the comparison between en-bloc resection surgery and debulking surgery for spinal tumors, including both primary and metastatic tumors. The databases of PubMed, Embase, Cochrane database, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was carried out and included all studies that directly compared en-bloc resection surgery with debulking surgery for spinal tumors in patients through March 2024. The primary outcomes included recurrence rate, postoperative metastasis rate, mortality rate, overall survival (OS), recurrence-free survival (RFS), complication, and so on. The statistical analysis was conducted using Review Manager 5.3. We systematically reviewed 868 articles and included 27 studies involving 1135 patients who underwent either en-bloc resection surgery (37.89%) or debulking surgery (62.11%). Our meta-analysis demonstrated significant advantages of en-bloc resection over debulking surgery. Specifically, the en-bloc resection group had a lower recurrence rate (OR = 0.19, 95%CI: 0.13–0.28, P < 0.00001), lower postoperative metastasis rate (P = 0.002), and lower mortality rate (P < 0.00001). Additionally, en-bloc resection could improve OS and RFS (HR = 0.45, 95%CI: 0.32–0.62, P < 0.00001 and HR = 0.37, 95%CI: 0.17–0.80, P = 0.01, respectively). However, en-bloc resection required longer operative times and was associated with a higher overall complication rate compared to debulking surgery (P = 0.0005 and P < 0.00001, respectively). The current evidence indicates that en-bloc surgical resection can effectively control tumor recurrence and mortality, as well as improve RFS and OS for patients with spinal tumors. However, it is crucial not to overlook the potential risks of perioperative complications. Ultimately, these findings should undergo additional validation through multi-center, double-blind, and large-scale randomized controlled trials (RCTs).

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脊柱肿瘤全切与切除的疗效和安全性：系统综述和荟萃分析

本系统综述和荟萃分析旨在整合现有证据，对脊柱肿瘤（包括原发性和转移性肿瘤）的全切除手术和剥离手术进行比较。该分析的数据库包括PubMed、Embase、Cochrane数据库、Web of Science、Scopus、中国国家知识基础设施（CNKI）、重庆VIP数据库（VIP）和万方数据库，纳入了截至2024年3月所有直接比较脊柱肿瘤全切手术和剥离手术的研究。主要结果包括复发率、术后转移率、死亡率、总生存率（OS）、无复发生存率（RFS）、并发症等。统计分析使用 Review Manager 5.3 进行。我们系统回顾了 868 篇文章，纳入了 27 项研究，涉及 1135 名患者，这些患者分别接受了全切手术（37.89%）或剥离手术（62.11%）。我们的荟萃分析表明，整体切除手术比分层手术具有显著优势。具体来说，全切组的复发率较低（OR = 0.19，95%CI：0.13-0.28，P < 0.00001），术后转移率较低（P = 0.002），死亡率较低（P < 0.00001）。此外，全块切除可改善 OS 和 RFS（分别为 HR = 0.45，95%CI：0.32-0.62，P < 0.00001 和 HR = 0.37，95%CI：0.17-0.80，P = 0.01）。然而，与剥离手术相比，全切手术需要更长的手术时间，并伴有更高的总体并发症发生率（P = 0.0005 和 P < 0.00001）。目前的证据表明，全椎切除手术能有效控制肿瘤复发和死亡率，改善脊柱肿瘤患者的RFS和OS。然而，不容忽视的是围手术期并发症的潜在风险。最终，这些研究结果应通过多中心、双盲和大规模随机对照试验（RCT）进行进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.