Recurrent upper cervical chordomas after radiotherapy: surgical outcomes and surgical approach selection based on complications
Retrospective review of a case series. To present and analyze our surgical results of recurrent chordomas in the upper cervical spine after radiotherapy and compare 2 surgical strategies. Surgical treatment of recurrent chordomas in the upper cervical spine after radiotherapy is clinically rare but extremely challenging. No reports are found in the literatures focusing on the surgical results and strategies of such recurrent chordomas. Clinical data of 8 patients with recurrent chordomas in the upper cervical spine after radiotherapy were retrospectively reviewed. Preoperative symptoms were relieved after our surgical procedures in 7 of the 8 patients. Total tumor removal was achieved in 6 of the 8 patients. Surgical complications mainly including cerebrospinal fluid leak and incision disunion were observed in 6 of the 8, and all the 3 patients after transoral operation had those complicated surgical complications, whereas the other 3 of the 5 patients after anterior retropharyngeal operation had relatively slighter complications. The disease free survival rates 1 year and 2 years after the surgery in this series were 50% and 12.5%, respectively, comparing with the general survival rates 1 year and 2 years after the surgery 87.5% and 37.5%. Revised surgery is effective for improving quality of life of patients with recurrent upper cervical chordomas after radiotherapy before further tumor recurrence. However, the prognosis of those patients is usually poor and surgical complications mainly including incision disunion and cerebrospinal fluid leak are common. To reduce the risk of surgical complications, anterior retropharyngeal approach may be superior to the transoral approach. N/A.