The outcomes of navigation-assisted bone tumour surgery

Abstract

We evaluated the oncological and functional outcome of 18 patients, whose malignant bone tumours were excised with the assistance of navigation, and who were followed up for more than three years. There were 11 men and seven women, with a mean age of 31.8 years (10 to 57). There were ten operations on the pelvic ring and eight joint-preserving limb salvage procedures. The resection margins were free of tumour in all specimens. The tumours, which were stage IIB in all patients, included osteosarcoma, high-grade chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma of bone, and adamantinoma. The overall three-year survival rate of the 18 patients was 88.9% (95% confidence interval (CI) 75.4 to 100). The three-year survival rate of the patients with pelvic malignancy was 80.0% (95% CI 55.3 to 100), and of the patients with metaphyseal malignancy was 100%. The event-free survival was 66.7% (95% CI 44.9 to 88.5). Local recurrence occurred in two patients, both of whom had a pelvic malignancy. The mean Musculoskeletal Tumor Society functional score was 26.9 points at a mean follow-up of 48.2 months (22 to 79). We suggest that navigation can be helpful during surgery for musculoskeletal tumours; it can maximise the accuracy of resection and minimise the unnecessary sacrifice of normal tissue by providing precise intra-operative three-dimensional radiological information.

Can computer navigation-assisted surgery reduce the risk of an intralesional margin and reduce the rate of local recurrence in patients with a tumour of the pelvis or sacrum?

“…17 Although computer navigation reduced the intralesional resection rate, 5 it was not possible to achieve the even more promising results described elsewhere, which reported clear margins in all of their navigated pelvic and sacral tumour resections. 15,16 In both of our patients with an intralesional soft tissue margin the bone resection margins were clear by 5 mm and 20 mm, respectively. Although the subsequent resection margins were clear in both cases, they were deemed to be contaminated resections.…”

“…More specifically, it reports the largest series of primary pelvic and sacral bone tumours resected using navigation. Recent reports from Cho et al 15 and Wong and Kumta 16 included ten and 12 patients, respectively, in whom a computer-navigated resection had been performed for a pelvic or sacral bone tumour. These two studies concurred with our view that computer navigation was a safe technique with no specific complications.…”

“…Most previous studies have achieved similar registration errors, 1,12,16,17 whereas others have accepted a more generous image-to-patient registration error of < 2 mm. 10,15 It has been suggested that to minimise this registration error, the time between imaging and surgical resection should be short. 17 Although computer navigation reduced the intralesional resection rate, 5 it was not possible to achieve the even more promising results described elsewhere, which reported clear margins in all of their navigated pelvic and sacral tumour resections.…”

Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours

“…Furthermore, an osteotomy performed freehand can lead to inaccurate resection planes impeding the implantation of the prosthesis. To minimise the risk of prosthesis failure and increase tumour resection accuracy, some authors suggest using computer-assisted navigation technologies [16][17][18]. However, navigation systems are not yet routinely used in pelvic tumour surgery, as they prolong operative time and require sufficient user experience and training to prevent technical errors in the registration process or the tracking system.…”

“…Some authors even suggest the use of intra-operative navigation software to improve the accuracy of the pelvic osteotomy [15,16]. However, only case series have been published so far, and long-term outcome after navigated pelvic tumour surgery remains to be determined [17,18].…”