Can Navigation-assisted Surgery Help Achieve Negative Margins in Resection of Pelvic and Sacral Tumors?

• Published in: Clinical orthopaedics and related research 2018-03, Vol.476 (3), p.499-508
• Main Authors: Abraham, John A, Kenneally, Barry, Amer, Kamil, Geller, David S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Magnetic Resonance Imaging; Male; Margins of Excision; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Orthopedic Procedures - mortality; Patient-Specific Modeling; Pelvic Neoplasms - diagnostic imaging; Pelvic Neoplasms - mortality; Pelvic Neoplasms - pathology; Pelvic Neoplasms - surgery; Retrospective Studies; Risk Factors; Sacrum - diagnostic imaging; Sacrum - pathology; Sacrum - surgery; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - mortality; Spinal Neoplasms - pathology; Spinal Neoplasms - surgery; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; Surgery, Computer-Assisted - mortality; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
• ISSN: 0009-921X; 1528-1132; 0009-921X
• DOI: 10.1007/s11999.0000000000000064

Navigation-assisted resection has been proposed as a useful adjunct to resection of malignant tumors in difficult anatomic sites such as the pelvis and sacrum where it is difficult to achieve tumor-free margins. Most of these studies are case reports or small case series, but these reports have been extremely promising. Very few reports, however, have documented benefits of navigation-assisted resection in series of pelvic and sacral primary tumors. Because this technology may add time and expense to the surgical procedure, it is important to determine whether navigation provides any such benefits or simply adds cost and time to an already complex procedure. (1) What proportion of pelvic and sacral bone sarcoma resections utilizing a computer-assisted resection technique achieves negative margins? (2) What are the oncologic outcomes associated with computer-assisted resection of pelvic and sacral bone sarcomas? (3) What complications are associated with navigation-assisted resection? Between 2009 and 2015 we performed 24 navigation-assisted resections of primary tumors of the pelvis or sacrum. Of those, four were lost to followup after the 2-year postoperative visit. In one patient, however, there was a failure of navigation as a result of inadequate imaging, so nonnavigated resection was performed; the remaining 23 were accounted for and were studied here at a mean of 27 months after surgery (range, 12-52 months). During this period, we performed navigation-assisted resections in all patients presenting with a pelvis or sacral tumor; there was no selection process. No patients were treated for primary tumors in these locations without navigation during this time with the exception of the single patient in whom the navigation system failed. We retrospectively evaluated the records of these 23 patients and evaluated the margin status of these resections. We calculated the proportion of patients with local recurrence, development of metastases, and overall survival at an average 27-month followup (range, 12-52 months). We queried a longitudinally maintained surgical database for any complications and noted which, if any, could have been directly related to the use of the navigation-assisted technique. In our series, 21 of 23 patients had a negative margin resection. In all patients the bone margin was negative, but two with sacral resections had positive soft tissue margins. Six of 23 patients experienced local recurrence within the study period. Three patie