Comparison of the lateral extracavitary and lateral thoracotomy surgical approaches for the treatment of thoracic spinal schwannomas.

BACKGROUND

Thoracic spinal schwannomas are benign nervesheath tumors that can cause significant neurological impairment. Surgical resection remains the treatment of choice and gold standard for achieving gross total resection and preventing recurrence. The lateral extracavitary approach (LECA) and lateral thoracotomy (LT) are commonly used techniques; however, the relative advantages of these two approaches remain uncertain, and comparative data in the Mexican population are lacking.

METHODS

We performed a retrospective cohort study of adults undergoing LECA or LT for thoracic spinal schwannoma at the National Cancer Institute of Mexico (2011-2018). Patients were selected according to tumor location, extension, cardiopulmonary tolerance, and surgeon experience, as detailed in the study methods. Demographic, radiological, and perioperative data were collected. Outcomes included tumor size/volume, operative time, estimated blood loss (EBL), length of stay (LOS), pain (Visual Analog Scale, VAS), neurological outcome (American Spinal Injury Association grade), and complications. Statistical significance was set at P < 0.05. Given the observed differences in tumor volume between groups, a dedicated statistical comparison was performed using the Mann-Whitney U test. In addition, a stratified analysis by tumor size (≤50 cm3 vs. >50 cm3) was conducted to evaluate whether differences between surgical approaches persisted within each stratum.

RESULTS

Forty-three patients were included (LECA n = 23; LT n = 20). Median EBL was lower with LECA (180 mL) versus LT (600 mL; P = 0.019). LECA had shorter operative time (median 3 h vs. 5 h; P < 0.001) and hospital stay (4 vs. 11 days; P = 0.004). Pain improved significantly after LECA (VAS 8→2; P < 0.001) but not after LT (9→7; P = 0.70). Tumor volume was significantly larger in the LT group (P < 0.0001), representing a potential confounder; however, the advantages of LECA persisted in the stratified analysis (≤50 cm3 and >50 cm3). Complications occurred in 10% (LECA) versus 25% (LT), not statistically significant given the small cohort. No perioperative mortality occurred.

CONCLUSION

In this single-center retrospective cohort, LECA was associated with reduced operative time, blood loss, LOS, and postoperative pain compared with LT. The potential benefits of LECA likely reflect improved exposure and reduced pleural morbidity inherent to the approach, though confounding by tumor size and patient selection cannot be excluded. Given the retrospective design and limited statistical power, findings should be interpreted cautiously and validated in prospective multicenter studies.