Utility of Three-Dimensional Printing for Preoperative Assessment of Children with Extra-Cranial Solid Tumors: A Systematic Review

Abstract

Background: In cases with solid tumors, preoperative radiological investigations provide valuable information on the anatomy of the tumor and the adjoining structures, thus helping in operative planning. However, due to a two-dimensional view in these investigations, a detailed spatial relationship is difficult to decipher. In contrast, three-dimensional (3D) printing technology provides a precise topographic view to perform safe surgical resections of these tumors. This systematic review aimed to summarize and analyze current evidence on the utility of 3D printing in pediatric extra-cranial solid tumors. Methods: The present study was registered on PROSPERO—international prospective register of systematic reviews (registration number: CRD42020206022). PubMed, Embase, SCOPUS, and Google Scholar databases were explored with appropriate search criteria to select the relevant studies. Data were extracted to study the bibliographic information of each article, the number of patients in each study, age of the patient(s), type of tumor, organ of involvement, application of 3D printing (surgical planning, training, and/or parental education). The details of 3D printing, such as type of imaging used, software details, printing technique, printing material, and cost were also synthesized. Results: Eight studies were finally included in the systematic review. Three-dimensional printing technology was used in thirty children with Wilms tumor (n = 13), neuroblastoma (n = 7), hepatic tumors (n = 8), retroperitoneal tumor (n = 1), and synovial sarcoma (n = 1). Among the included studies, the technology was utilized for preoperative surgical planning (five studies), improved understanding of the surgical anatomy of solid organs (two studies), and improving the parental understanding of the tumor and its management (one study). Computed tomography and magnetic resonance imaging were either performed alone or in combination for radiological evaluation in these children. Different types of printers and printing materials were used in the included studies. The cost of the 3D printed models and time involved (range 10 h to 4–5 days) were reported by two studies each. Conclusions: 3D printed models can be of great assistance to pediatric surgeons in understanding the spatial relationships of tumors with the adjacent anatomic structures. They also facilitate the understanding of families, improving doctor–patient communication.

Use of modern three‐dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors

“…7,8 While magnetic resonance imaging (MRI) and computed tomography (CT) have been the foundation of preoperative oncologic imaging, 4 incorporating 3D modeling and printing for enhanced visualization appears beneficial. 9 Specifically, within pediatric oncology, previous work has suggested that 3D printing may be useful for complex tumor resections, 10,11 though these techniques have yet to be published within the United…”

Current trends and prospects of surgical techniques for hepatoblastoma

“…Compared with imaging examination results, such as MRI data, 3D printing enables surgeons to more intuitively understand the relationship between tumors and surrounding tissues and to perform preoperative simulation operations. 4,5 Sánchez et al used real-time 3D printing before and during surgery to perform a more thorough and safer resection of complex tumors. About 15% of complicated hepatoblastoma cases cannot be surgically removed after chemotherapy and need liver transplantation.…”

“…Three‐dimensional (3D) printing software uses preoperative imaging examination data for 3D visualization and then prints tumors and adjacent tissues and organs using different materials. Compared with imaging examination results, such as MRI data, 3D printing enables surgeons to more intuitively understand the relationship between tumors and surrounding tissues and to perform preoperative simulation operations 4,5 . Sánchez et al.…”

“…(3) The presence of very large tumors, multiple tumors, or tumors in vital organs, which are difficult to completely remove. (4) Tumors that surround or invade large blood vessels may cause fatal, massive hemorrhage upon removal. (5) Intravascular or even cardiac tumor thrombosis may have serious consequences, including pulmonary embolism.…”

Case Study of Precise Soft-Tissue Sarcoma Operation Based on Three-Dimensional Modeling Technology

“…There are many cases of 3D modeling technology in the medical field at home and abroad, mainly used in orthopedic material preparation, thoracic surgery, maxillofacial plastic surgery, hepatobiliary surgery, and other disciplines (2,6,(8)(9)(10)(11). However, there are few reports on the application of this technology in the surgical treatment of complex soft tissue malignant tumors (12). This paper reports the complete resection of a complex soft tissue malignant tumor of the left thigh under the guidance of 3D modeling technology.…”