Surgical navigation for challenging recurrent or pretreated intra‐abdominal and pelvic soft tissue sarcomas

Reijers, Sophie; Heerink, Wouter J.; Veen, Ruben van; Nijkamp, Jasper; Hoetjes, Nikie; Schrage, Yvonne; Akkooi, Alexander C. J. van; Beets, Geerard L.; Coevorden, Frits van; Ruers, Theo J.M.; Groen, Harald C.; Houdt, Winan J. van

doi:10.1002/jso.26624

Cited by 4 publications

(5 citation statements)

References 18 publications

(32 reference statements)

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“…A surgical navigation setup for abdominal surgery was developed and evaluated in-house at the Netherlands Cancer Institute (NKI) [ 18 , 19 ]. This setup has resulted in numerous patient studies that demonstrate the added value of the technology [ 18 , 19 , 20 , 21 ]. Among patients operated on for LRRC, R0 resection rate using surgical navigation was 21% compared with 51% in a case control group [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer

Groen

Hartog

Heerink

et al. 2022

Life

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Surgery for locally recurrent rectal cancer (LRRC) presents several challenges, which is why the percentage of inadequate resections of these tumors is high. In this exploratory study, we evaluate the use of image-guided surgical navigation during resection of LRRC. Patients who were scheduled to undergo surgical resection of LRRC who were deemed by the multidisciplinary team to be at a high risk of inadequate tumor resection were selected to undergo surgical navigation. The risk of inadequate surgery was further determined by the proximity of the tumor to critical anatomical structures. Workflow characteristics of the surgical navigation procedure were evaluated, while the surgical outcome was determined by the status of the resection margin. In total, 20 patients were analyzed. For all procedures, surgical navigation was completed successfully and demonstrated to be accurate, while no complications related to the surgical navigation were discerned. Radical resection was achieved in 14 cases (70%). In five cases (25%), a tumor-positive resection margin (R1) was anticipated during surgery, as extensive radical resection was determined to be compromised. These patients all received intraoperative brachytherapy. In one case (5%), an unexpected R1 resection was performed. Surgical navigation during resection of LRRC is thus safe and feasible and enables accurate surgical guidance.

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Section: Introductionmentioning

confidence: 99%

Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer

Groen

Hartog

Heerink

et al. 2022

Life

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“…Other localization techniques include intraoperative US guidance, optical tracing, and surgical navigation technology by using a preoperatively constructed 3-dimensional tumor model, which our group has published for the use in STS patients. 13 The different localization strategies have upsides and downsides compared with the 99m Tc ROLL technique. A common disadvantage among all markers is that they must be inserted in the lesion with an invasive procedure, which can be a burden for a patient.…”

Section: Discussionmentioning

confidence: 99%

“…Besides the 99m Tc ROLL technique, other invasive markers that have been studied are, for example, radioactive seed localization (RSL), magnetic seed localization (MSL), and wire-guided localization (WGL). Other localization techniques include intraoperative US guidance, optical tracing, and surgical navigation technology by using a preoperatively constructed 3-dimensional tumor model, which our group has published for the use in STS patients 13 …”

Section: Discussionmentioning

confidence: 99%

Radio-Guided Occult Lesion Localization With 99mTc for the Localization of Nonpalpable Melanoma and Soft Tissue Sarcoma Lesions: A Feasibility Study

Reijers,

Mook,

Groen

et al. 2023

Clin Nucl Med

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Purpose of the Report Localization techniques are needed to facilitate resection of nonpalpable lesions. In this study, the feasibility of radio-guided occult lesion localization (ROLL) with 99mTc is investigated for the localization of nonpalpable, small, suspicious, or proven melanoma or soft tissue sarcoma lesions at various locations throughout the body. Patients and Methods Patients with nonpalpable, suspicious, or proven melanoma or soft tissue sarcoma lesions were selected for this study. Within 24 hours before surgery, a median dose of 33.92 MBq 99mTc-labeled human albumin particles (99mTc-NA or 99mTc-MAA) was injected in the lesion under ultrasound guidance. A hand-held gamma probe was used to detect the radioactive signal and guidance during surgery. Results In this study, 20 patients with a total of 25 lesions were included and analyzed. The median size of the lesions was 1.8 cm (interquartile range [IQR], 1.8–4.0 cm), of which 44% were intramuscular located and 36% were subcutaneous, and 20% consisted of suspicious lymph nodes, mostly in the lower extremity. At median 4 hours (IQR, 3–6 hours) postinjection, 99mTc ROLL showed a 100% intraoperative identification rate with proper signal identification with the gamma probe in all patients. With a median surgery time of 76 minutes (IQR, 45–157 minutes), all targeted lesions could be resected without 99mTc-related complications, resulting in 88% microscopically margin-negative resection. No reoperations were needed for the same lesion. Conclusions The 99mTc ROLL procedure is feasible for the localization and excision of small, nonpalpable melanoma and soft tissue sarcoma lesions at various locations in the body.

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“…Only the bony anatomy remains the same… soft tissue resection still requires a conventional surgical technique.” 13 In the only series of human soft‐tissue sarcomas to undergo attempted CT‐guided navigation, Bosma et al reported no improvement in WLE success 27 . Reijers et al reported probe‐based electromagnetic navigation for soft‐tissue sarcomas of the abdomen, however, lessons were limited due to sample size 46 …”

Section: Discussionmentioning

confidence: 99%

Fluorescence guidance improves the accuracy of radiological imaging‐guided surgical navigation

Henderson

Hebert

Werth

et al. 2022

Journal of Surgical Oncology

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Background Imaging‐based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging‐based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft‐tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging‐based navigation to guide the dissection of soft‐tissue phantom tumors. Methods Using a human tissue‐simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. Results Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. Conclusions At present, imaging‐based navigation has limited application in guiding soft‐tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging‐based navigation and may be best viewed as a synergistic technology, rather than a competing one.

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Surgical navigation for challenging recurrent or pretreated intra‐abdominal and pelvic soft tissue sarcomas

Cited by 4 publications

References 18 publications

Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer

Use of Image-Guided Surgical Navigation during Resection of Locally Recurrent Rectal Cancer

Radio-Guided Occult Lesion Localization With 99mTc for the Localization of Nonpalpable Melanoma and Soft Tissue Sarcoma Lesions: A Feasibility Study

Fluorescence guidance improves the accuracy of radiological imaging‐guided surgical navigation

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