Computer navigation-assisted surgical techniques in the surgical resection of pelvic chondrosarcomas / 中华骨科杂志

ABSTRACT

Objective:To explore the clinical effects of computer navigation-assisted surgery in the precise resection of pelvic chondrosarcoma.Methods:A retrospective analysis of 54 patients who had computer-assisted surgery from Dec 2007 to Dec 2018, including 27 males and 27 females, was conducted. The average age was 34.00±1.41 years (range 23-72 years). There were 47 cases with primary tumors and 7 with recurrence cases. The tumors in 15 cases located in the ilium (region I), 35 in the acetabulum (region II), 1 in the pubic (region III), and 3 in the sacroiliac joint (region IV). A total of 45 cases (83.3%) underwent needle biopsy, and 4 cases (7.4%) had incision biopsy. Among 5 cases who did not have biopsy, two of them was diagnosed of malignant change of multiple osteochondromas, two cases were diagnosed of recurrent pelvic chondrosarcoma and one with pelvic malignant tumor by imaging examinations. Pathological grade was presented as following, 36 cases in grade I, 15 in grade II, and 3 in grade III. All operations were performed on the bases of preoperative design with computer navigation-assisted surgical technology. A total of 49 cases (90.7%) had limb salvage operations and 5 cases had amputations. The surgical margins were confirmed by gross appearance and the maximum diameter profile of the tumor. Univariate analysis was performed to compare recurrence rate of different preoperative tumor status, gender, tumor stage, biopsy method, tumor location, operation method and surgical margins.Results:There were 39 cases underwent extensive resection, 13 cases with marginal resection and 2 cases with intracapsular resection. In 52 cases (96.3%), the surgery was performed according to the preoperative plan of surgical resection margin. However, two cases (3.7%) was not performed based on the preoperative plan. All patients were followed-up for 84.00±93.34 months (range 12-150 months). During the follow-up, a total of 45 cases (83.3%) survived and 9 cases died from lung metastasis. Eight cases (14.8%, 8/54) had local recurrence of whom 7 (14.3%) were limb salvage cases and 1 (20.0%, 1/5) had amputation. There was significantly different in local recurrence rate (χ 2=17.022, P=0.001). The risk of recurrence of marginal resection was 8.222 times than that of extensive resection [95% CI (1.297, 52.140)]. According to the Musculoskeletal Tumor Society (MSTS) limb function evaluation system score, postoperative limb function recovery rate was 90.00%±4.71% (range 60.00%-100%). There were 13 cases (24.1%) had postoperative complications, including 7 cases (13.0%) of infection, 2 cases (3.7%) of operative area and deep vein thrombosis of lower extremity, and 4 cases (7.4%) of skin necrosis and delayed healing. Among 49 limb salvage patients, two of them had secondary amputation due to tumor recurrence, five had hemipelvectomy due to neurovascular tumor invasion. The final limb salvage rate was 77.8% (42/54). Conclusion:Computer navigation-assisted precise pelvic tumor resection is technically feasible. It could decrease recurrence rate and promote limb function recovery by improving the reliability of oncology evaluation and the accuracy of tumor resection with superior safety.