Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery

Abstract

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are increasingly being used to plan complex cases bringing new insights into pediatric tumors to guide therapeutic decisions and prognosis in different pediatric surgical oncology areas and locations including thoracic, brain, urology, and abdominal surgery. Despite this, challenges to their adoption remain, especially in soft tissue-based specialties such as pediatric surgical oncology. This work explores the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications through the analysis of three real cases of the most common and surgically challenging pediatric tumors: abdominal neuroblastoma, thoracic inlet neuroblastoma, and a bilateral Wilms tumor candidate for nephron-sparing surgery. The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases. A comprehensive analysis of the advantages and limitations of each technique has been carried out to assist in choosing the optimal approach.

The role of Pediatric Surgery in childhood cancer

“…Moreover, the implementation of enhanced recovery programs in pediatric oncology surgery, as reported by Wells et al 16 , has been shown to improve patient outcomes, underscoring the importance of postoperative management training and specialization. Advancements in surgical approaches, such as the use of three-dimensional (3D) models and augmented reality over conventional imaging for preoperative assessment in Wilms tumor cases 17 , 18 , also emphasize the impact of specialized training. Furthermore, fellowship in pediatric oncologic surgery has been linked to improved survival rates, indicating the positive effect of specialized training on optimizing therapy based on risk stratification algorithms 9 .…”

“…These technologies offer an unparalleled depth of insight into complex anatomical structures, enabling surgeons to plan and execute surgical interventions with enhanced precision. 3D reconstructions, including cinematic rendering and volume rendering, provide a detailed visualization of pediatric tumors, significantly aiding in therapeutic decisions and prognostic assessments in various areas such as thoracic, brain, urology, and abdominal surgery 18 . The use of these technologies in the preoperative assessment of children, for instance, in cases like Wilms tumors, has demonstrated potential for guiding surgical decision-making 17 .…”

“…These advanced imaging techniques enable surgeons to tailor diagnosis and treatment plans more accurately, thus improving surgical outcomes and patient care. However, the integration of these technologies in varied clinical settings, especially in low-resource environments, presents challenges, including the limited availability of advanced imaging equipment, the high costs involved, and the need for specialized training 17 , 18 , 20 .…”

The guiding value of the cinematic volume rendering technique in the preoperative diagnosis of brachial plexus schwannoma

“…It then rendered the tumor and brachial plexus in different colors to improve the sharpness of the tissue edge without redundant background interference. In addition, some studies have also shown that the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications can be helpful in the future preoperative planning of surgery for pediatric tumors ( 30 , 31 ).Therefore, cVRT can accurately show the positional relationship between the tumor and the brachial plexus, which is very important for evaluating its risk, preventing complications, and formulating treatment plans.…”

Children's Oncology Group's 2023 blueprint for research: Surgery

“…Post‐processing techniques, including 3D imaging projections (e.g., volume rendering, cinematic rendering, 3D modeling techniques, 3D printing, virtual reality, and augmented reality) enhance surgical planning 48–50 . These technologies enable personalization and 3D visualization of the tumor, surrounding vasculature, and other anatomic structures in the surgical field.…”