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Navigation-assisted tumor resection helped yield negative margins
Results published in Clinical Orthopaedics and Related Research showed a high likelihood of negative margin resection with navigation-assisted resection of pelvic and sacral tumors.
“This study looked specifically at the use of navigation and allowed us to get a better resection in a relatively large number of patients, given that it is a rare tumor,” John A. Abraham, MD, co-author of the study, associate professor at Thomas Jefferson University and director of the Jefferson Sarcoma and Bone Tumor Center, told Healio.com/Orthopedics.
Abraham and colleagues performed navigation-assisted resections in 23 patients who presented with a pelvis or sacral tumor between 2009 and 2015. Researchers evaluated the margin status of the resections and calculated the proportion of patients with local recurrence, development of metastases and overall survival at an average 27-month follow-up. A longitudinally maintained surgical database was queried for any complications, and researchers identified whether any of the complications were directly related to the use of the navigation-assisted technique.
Results showed 21 patients had a negative margin resection and two patients who underwent sacral resections had positive soft tissue margins. During the study period, researchers noted six patients experienced local recurrence and three patients died. At last recorded follow-up, no evidence of disease was found in 17 patients. Researchers noted a dural tear in one patient, an iliac vein laceration in one patient and a bladder injury in one patient, as well as wound complications resulting in operative debridement in eight patients. Transient postoperative femoral nerve palsy was developed by two patients. Researchers noted this may have been caused by stretching of the “femoral nerve secondary to the placement of the reference array in the pubic ramus.”
“The next step in the research is figuring out what aspect of computer-aided surgery will be the most beneficial for removing these difficult tumors,” Abraham said. – by Casey Tingle
Disclosure: Abraham reports no relevant financial disclosures.
Perspective
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Using currently available technology, NAS is less effective at ensuring a negative soft tissue margin. In addition, in order to precisely execute difficult bony resections, one must understand the technology and learn to accommodate its technical limitations. Perhaps the greatest value of NAS is akin to the salient advice encapsulated by the traditional orthopedic aphorism, “measure twice, cut once.” With accurate registration and location accuracy, NAS is helpful in planning and executing complicated resection planes in three dimensions, especially when surgical dissection is complicated by difficult anatomy made worse when distorted by large destructive tumors. Ostensibly elegant but often practically cumbersome, it is possible that NAS will be replaced (or aided) in certain circumstances by 3D-printed cutting guides as a potentially simpler and more cost-effective alternative.