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Computer-assisted Tumor Surgery in Malignant Bone Tumors

  • Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Small recent case series using CT-based navigation suggest such approaches may aid in surgical planning and improve accuracy of intended resections, but the accuracy and clinical use have not been confirmed.

Questions/purposes

We therefore evaluated (1) the accuracy; (2) recurrences; and (3) function in patients treated by computer-assisted tumor surgery (CATS).

Methods

From 2006 to 2009, we performed CATS in 20 patients with 21 malignant tumors. The mean age was 31 years (range, 6–80 years). CT and MR images for 18 cases were fused using the navigation software. Reconstructed two-dimensional/three-dimensional images were used to plan the bone resection. The achieved bone resection was compared with the planned one by assessing margins, dimensions at the level of bone resection, or fitting of CAD custom prostheses. Function was assessed with the Musculoskeletal Tumor Society (MSTS) score. The minimum followup was 31 months (mean, 39 months; range, 5–69 months).

Results Histological examination of all resected specimens showed a clear tumor margin. The achieved bone resection matched the planned with a difference of ≤ 2 mm. The achieved positions of custom prostheses were comparable to the planned positions when merging postoperative with preoperative CT images in five cases. Three of the four patients with local recurrence had tumors at the sacral region. The mean MSTS score was 28 (range, 23–30).

Conclusion

CATS with image fusion allows accurate execution of the intended bone resection. It may be beneficial to resection and reconstruction in pelvic, sacral tumors and more difficult joint-preserving intercalated tumor surgery. Comparative clinical studies with long-term followup are necessary to confirm its efficacy.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mr Sudha Shunmugam (biomedical engineer), the design team, and Dr Paul Unwin (Stanmore Implants, Elstree, UK) for design and manufacture of the CAD custom prostheses. We acknowledge the great assistance of Mr Rock Hu and Ms Yukin Zhao (Bio-Medical Engineering, Materialise China) in using the MIMICS software.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong

    Kwok Chuen Wong MD & Shekhar Madhukar Kumta MD

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  1. Kwok Chuen Wong MD
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  2. Shekhar Madhukar Kumta MD
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Correspondence to Kwok Chuen Wong MD.

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Wong, K.C., Kumta, S.M. Computer-assisted Tumor Surgery in Malignant Bone Tumors. Clin Orthop Relat Res 471, 750–761 (2013). https://doi.org/10.1007/s11999-012-2557-3

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