A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: a prospective study

Abstract

Background: Positive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery (CAS) and patient-specific surgical guides, we can accurately execute the preoperative osteotomy plan. However, how well we can predict the margin distance in the final histopathology with a preoperative CT scan, the factors associated with it, and how much leeway we should spare when designing the osteotomy planes during virtual surgical planning remain to be investigated. Materials and Methods: Patients from Jan 2021 to Dec 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. Virtual surgical planning (VSP) and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes. Results: A total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected (P=0.19), and there was a strong correlation between the two (rs=0.74, P<0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in CT scan and final histopathology (overall SD=6.26▓mm, malignancy SD=7.44▓mm, benign SD=4.40▓mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed (P=0.16). Conclusion: Bone margin distance in VSP is reliably correlated to final pathological margin distance. A leeway distance of 15▓mm and 9▓mm should be considered when designing the osteotomy planes for malignancy and benign cases respectively. Extra attention should be paid to maxilla cases when pre-determining the osteotomy planes during virtual surgical planning.

Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review

“…It must be pointed out that patient-specific planning requires more time than a lack of planning, for the PSR company and/or for the surgeon, but various articles and common sense suggest that planned surgery provides better outcomes than unplanned surgery [71,72]. Additionally, the planning should be prepared before the surgical procedure, allowing for the surgeon to concentrate on planning when outside the operating room and on the patient once inside [73,74].…”

Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes

“…CAD/CAM systems require the establishment of oncologic margins preoperatively in order to produce anatomic models and cutting guides. While there was initial uncertainty regarding the control of locoregional disease with preplanned margins, several studies have shown similar rates of negative intraoperative and final margins, as well as short and long-term recurrences 2 , 21 . Oncological safety of the method is now established, but requires presurgical evaluation of margins on recent CT and MRI, that too much time does not pass between planning and surgery, accurate correlation of the clinical and radiological data, and preoperative collaboration of ablative and reconstructive surgeons via videoconference.…”