En-bloc resection for spinal giant cell tumors: superior outcomes-a comprehensive meta-analysis and trial sequential analysis

Spinal giant cell tumors (GCTs) management primarily involves surgical resection; however, the optimal surgical approach continues to be a subject of debate. This study aims to comprehensively compare the efficacy of en-bloc resection with that of control resection techniques, specifically intralesional curettage and piecemeal resection, in the treatment of spinal GCTs. A comprehensive search of English databases, including the Cochrane Library, Embase, PubMed, Scopus, and Web of Science, as well as Chinese databases such as the National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wan Fang, was conducted up to January 2024. This search identified twelve studies encompassing 492 participants. The meta-analysis indicated that en-bloc resection significantly reduces recurrence rates (OR = 0.27, 95% CI: 0.15-0.47, P < 0.00001) and mortality (OR = 0.16, 95% CI: 0.03-0.88, P = 0.04) when compared to control resection techniques. Notably, en-bloc resection demonstrated superior performance over control methods in both 1-year and 5-year relapse-free survival (RFS) rates (P = 0.001 and P < 0.00001, respectively), as well as in overall RFS (HR = 0.27, 95% CI: 0.08-0.91; P = 0.04). Despite its advantages, en-bloc excision was associated with a higher overall complication rate (P = 0.01). Furthermore, trial sequential analysis (TSA) suggests that the current sample size is inadequate to draw definitive conclusions, thereby underscoring the necessity for further investigations. En-bloc resection shows significant advantages over control resection techniques in reducing recurrence rates, mortality, and improving RFS. However, the higher complication rates and TSA findings stress the need for more high-quality studies to verify the benefits and safety of en-bloc resection in spinal GCT treatment.