Chordoma is a rare slow-growing neoplastic bone lesion. However, they show an invasive local growth and high recurrence rate, leading to an overall survival rate of 65% at 5 years and 35% at 10 years. We conducted a pooled and meta-analysis comparing recurrence rate, post-operative-complications, and survival in patients undergoing either microsurgical (MA) or endoscopic approaches (EA). Search of literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify surgical series of clivus chordomas published between January 1990 and March 2018 on Pubmed, Scopus, and Cochrane. Two different statistical analyses have been performed: a pooled analysis and a single-arm meta-analysis of overall recurrence rate and subgroup meta-analysis of complications in the subgroups open surgery and endoscopic surgery. After full-text screening, a total of 58 articles were included in the pooled analysis and 27 studies were included for the study-level meta-analysis. Pooled analysis-the extent of resection was the only association that remained significant (subtotal: HR = 2.18, p = 0.004; partial: HR = 4.40, p < 0.001). Recurrence was more prevalent among the surgical patients (45.5%) compared to endoscopic ones (23.7%). Meta-analysis-results of the cumulative meta-analysis showed an overall rate of recurrence of 25.6%. MA recurrence rate was 31.8% (99% CI 14-52.8), EA recurrence rate was 19.4% (5.4-39.2). CSF leak rate for the endoscopic group was 10.3% (99%CI 5-17.3) and 9.5% (99%CI 1.2-24.6) for the open surgery group. The partial removal versus total removal has an influence on recurrence rate (p < 0.001). MA recurrence rate was 31.8%; EA recurrence rate was 19.4%. The extent of resection is confirmed as a statistically significant factor affecting the risk for recurrence both with the pooled analysis and with the meta-analysis. Meta-analysis demonstrated that older patients tend to recur more than young patients, especially in surgical group.

中文翻译：

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显微外科与内窥镜经蝶入路治疗斜坡脊索瘤：汇总和荟萃分析。

脊索瘤是一种罕见的缓慢生长的肿瘤性骨病变。然而，它们显示出侵入性局部生长和高复发率，导致 5 年总生存率为 65%，10 年总生存率为 35%。我们进行了一项汇总和荟萃分析，比较了接受显微外科手术 (MA) 或内窥镜手术 (EA) 的患者的复发率、术后并发症和生存率。根据系统评价和元分析首选报告项目 (PRISMA) 指南进行文献检索，以确定 1990 年 1 月至 2018 年 3 月在 Pubmed、Scopus 和 Cochrane 上发表的斜坡脊索瘤手术系列。进行了两种不同的统计分析：总体复发率的汇总分析和单臂荟萃分析以及亚组开放手术和内窥镜手术并发症的亚组荟萃分析。全文筛选后，共有58篇文章被纳入汇总分析，27项研究被纳入研究级荟萃分析。汇总分析 - 切除范围是唯一保持显着的关联（小计：HR = 2.18，p = 0.004；部分：HR = 4.40，p < 0.001）。与内窥镜患者 (23.7%) 相比，手术患者 (45.5%) 的复发率更高。累积荟萃分析的荟萃分析结果显示总体复发率为 25.6%。MA 复发率为 31.8% (99% CI 14-52.8)，EA 复发率为 19.4% (5.4-39.2)。内窥镜组的脑脊液漏率为 10.3% (99%CI 5-17.3) 和 9.5% (99%CI 1. 2-24.6) 为开放手术组。部分去除与全部去除对复发率有影响 (p < 0.001)。MA复发率为31.8%；EA 复发率为 19.4%。通过汇总分析和荟萃分析，切除范围被确认为影响复发风险的统计学显着因素。荟萃分析表明，老年患者比年轻患者更容易复发，尤其是手术组。