The role of Intraoperative 3D navigation for pelvic bone tumor resection

Pelvic bone tumor resection is challenging due to complex geometry, limited visibility, and restricted workspace. Accurate resection including a safe margin is required to decrease the risk of local recurrence. This clinical study reports 11 cases of pelvic bone tumor resected by using patient-specific instruments. Magnetic resonance imaging was used to delineate the tumor and computerized tomography to localize it in 3D. Resection planning consisted in desired cutting planes around the tumor including a safe margin. The instruments were designed to fit into unique position on the bony structure and to indicate the desired resection planes. Intraoperatively, instruments were positioned freehand by the surgeon and bone cutting was performed with an oscillating saw. Histopathological analysis of resected specimens showed tumor-free bone resection margins for all cases. Available postoperative computed tomography was registered to preoperative computed tomography to measure location accuracy (minimal distance between an achieved and desired cut planes) and errors on safe margin (minimal distance between the achieved cut planes and the tumor boundary). The location accuracy averaged 2.5 mm. Errors in safe margin averaged −0.8 mm. Instruments described in this study may improve bone tumor surgery within the pelvis by providing good cutting accuracy and clinically acceptable margins.

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Pelvic bone tumor resection: post-operative imaging

Skeletal Radiology ◽

10.1007/s00256-020-03703-6 ◽

2021 ◽

Author(s):

Shivani Ahlawat ◽

Michael McColl ◽

Carol D. Morris ◽

Laura M. Fayad

Keyword(s):

Bone Tumor ◽

Tumor Resection ◽

Pelvic Bone ◽

Bone Tumor Resection

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A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽

10.3390/antibiotics10070768 ◽

2021 ◽

Vol 10 (7) ◽

pp. 768

Author(s):

Yoann Varenne ◽

Stéphane Corvec ◽

Anne-Gaëlle Leroy ◽

David Boutoille ◽

Mỹ-Vân Nguyễn ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Bone Tumor ◽

Tumor Resection ◽

Surgical Site Infections ◽

Implant Removal ◽

Pelvic Bone ◽

Resistance Pattern ◽

Cure Rate ◽

Implant Retention ◽

The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

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Complex Bone Tumors of the Trunk—The Role of 3D Printing and Navigation in Tumor Orthopedics: A Case Series and Review of the Literature

Journal of Personalized Medicine ◽

10.3390/jpm11060517 ◽

2021 ◽

Vol 11 (6) ◽

pp. 517

Author(s):

Martin Schulze ◽

Georg Gosheger ◽

Sebastian Bockholt ◽

Marieke De Vaal ◽

Tymo Budny ◽

...

Keyword(s):

3D Printing ◽

Tumor Resection ◽

Case Series ◽

Main Process ◽

Patient Centered ◽

Individual Care ◽

Real Time Visualization ◽

Bone Tumor Resection ◽

Virtual Modeling

The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.

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Therapy and regeneration-combined bone cements for minimally invasive treatment of neoplastic bone defects

Journal of Materials Chemistry B ◽

10.1039/d1tb00703c ◽

2021 ◽

Author(s):

Yu Qu ◽

Hui Zhuang ◽

Meng Zhang ◽

Yufeng Wang ◽

Dong Zhai ◽

...

Keyword(s):

Calcium Phosphate ◽

Minimally Invasive ◽

Tumor Cells ◽

Bone Tumor ◽

Tumor Resection ◽

Bone Defects ◽

Bone Cements ◽

Invasive Treatment ◽

Calcium Phosphate Cements ◽

Bone Tumor Resection

Although calcium phosphate cements (CPC) have been clinically used to repair bone defects caused by bone tumor resection, traditional CPC cannot kill the remaining tumor cells after surgery and prevent...

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The Accuracy of Three-Dimensional Planned Bone Tumor Resection Using Patient-Specific Instrument

Cancer Management and Research ◽

10.2147/cmar.s228038 ◽

2020 ◽

Vol Volume 12 ◽

pp. 6533-6540

Author(s):

Daniel A Müller ◽

Yannik Stutz ◽

Lazaros Vlachopoulos ◽

Mazda Farshad ◽

Philipp Fürnstahl

Keyword(s):

Bone Tumor ◽

Tumor Resection ◽

Three Dimensional ◽

Patient Specific ◽

Specific Instrument ◽

Bone Tumor Resection

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Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children

Sarcoma ◽

10.1155/2015/892141 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ahmed Hamed Kassem Abdelaal ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

Shinji Miwa ◽

...

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Bone Tumor ◽

Treatment Options ◽

Tumor Resection ◽

Limb Salvage Surgery ◽

Leg Length ◽

Primary Bone Tumors ◽

Bone Tumor Resection ◽

Bone Autograft

Limb salvage surgery has become the standard treatment for malignant primary bone tumors in the extremities. Limb salvage represents a challenge in skeletally immature patients. Several treatment options are available for limb reconstruction after tumor resection in children. We report our results using the technique of epiphyseal sparing and reconstruction with frozen autograft bone in 18 children. The mean follow-up period for the all patients included in this study is 72 ± 26 m. Eight patients remained disease-free, seven patients lived with no evidence of disease, two were alive but with disease, and one patient died of the disease. Five- and ten-year rates of survival were 94.4%. Graft survival at 5 and 10 years was 94.4%. Functional outcome using the Enneking scale was excellent in 17 patients (94.4%) and poor in one patient (5.5%). Complications include 2 nonunions, 2 fractures, 2 deep infections, 1 soft tissue recurrence, and leg length discrepancy in 7 cases. This technique is a good reconstructive choice in a child with a nonosteolytic primary or secondary bone tumor, responsive to chemotherapy, without involvement of the articular cartilage. It is a straight forward, effective, and biological technique, which affords immediate mobilization of joints and possible cryoimmune effects, with excellent long term functional outcome and less complication.

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