Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors

Abstract

We sought to assess the early clinical outcome of 3D-multimodality image (3DMMI)based virtual surgical planning for resection and reconstruction of malignant giant pelvic tumors. Patients and methods: In this retrospective case-control study, surgery was planned and performed with 3DMMI-based patient-specific instruments (PSI) in 13 patients with giant pelvic malignancy and without 3DMMI-based PSI in the other 13 patients. In the 3DMMI group, 3DMMI was utilized, taking advantages of computed tomography (CT), contrast-enhanced CT angiography (CTA), contrast-enhanced magnetic resonance imaging (MRI), contrast-enhanced magnetic resonance neurography (MRN), which could reveal the whole tumor and all adjacent vital structures. Based on these 3DMMI, virtual surgical planning was conducted and the corresponding PSI was then designed. The median follow-up was 8 (3-24) months. The median age at operation was 37.5 (17-64) years. The mean tumor size in maximum diameter was 13.3 cm. Surgical margins, intraoperative and postoperative complications, duration of surgery, and intra-operative blood loss were analyzed. Results: In the non-3DMMI group, the margins were wide in six patients (6/13), marginal in four (4/13), wide-contaminated in two (2/13), and intralesional in one (1/13). In the 3DMMI group, the margins were wide in 10 patients (10/13), marginal in three (3/13), and there were no wide-contaminated or intralesional margins. The 3DMMI group achieved shorter duration of surgery (P=0.354) and lower intraoperative blood loss (P=0.044) than the non-3DMMI group. Conclusion: The 3DMMI-based technique is advantageous to obtain negative surgical margin and decrease surgical complications related to critical structures injury for malignant giant pelvic tumor.

3D-printed Prostheses Assisted by Osteotomy Guide Plates for Reconstruction Following Periacetabular Tumor Resection via Two Approaches

“…This complication did not occur in the other ve patients, even including the patient who had died at the last follow-up. This is not surprising because previous studies have veri ed that there is a signi cant relationship between the incidence of local recurrence and the surgical margin [32], with 70%-100% of local recurrence cases resulting from marginal and intralesional resection [33]. In addition, there were no cases of nerve damage, skin necrosis or dislocation in the study.…”

“…Rigorous preoperative planning is crucial in pelvic tumor surgery. Using a 3D-printed proportional pelvic model, surgeons can simulate hands-on surgical resection and reconstruction prior to the real operation [33].…”

Treatment of massive iliac chondrosarcoma with personalized three-dimensional printed tantalum implant: a case report and literature review

“…Several reports have described the application of 3D printed implants in orthopedic surgeries, including pelvic, femoral, and tibial arthroplasty. 16 – 20 A group of spine surgeons in China used a customized artificial vertebral body fabricated according to a computer model using tantalum powder to reconstruct the cervical spine of a 12-year-old boy with Ewing sarcoma of the C2 vertebra after staged spondylectomy. 21 One year after the surgery, implant osseointegration was confirmed in sagittal reconstruction images as indicated by bone ingrowth into the built-in vertical slit in the center.…”

Preoperative Planning Using Three-Dimensional Multimodality Imaging for Soft Tissue Sarcoma of the Axilla: A Pilot Study

“…In the 3DMMI group, MRI and MRN were mapped to CT in register using affine and diffeomorphic registration algorithms in advanced normalisation tools [11]. The tumour and adjacent critical structures were segmented with level-set, region-grow, and threshold control in 3D Slicer 4.11 (www.slicer.org, accessed on 20 March 2022) [15].…”

“…3D multimodality imaging (3DMMI) is generated by radiologists using image registration and segmentation algorithms based on each imaging modality, where different images synergistically contribute to a more reliable computer-generated objective tumour building. Currently, 3DMMI is applied in neurosurgery, radiation therapy, and bone oncology surgery, where is demonstrates promising efficacy in clinical practice [10][11][12][13]. However, no relevant STS studies have been performed.…”