Guided pelvic resections in tumor surgery


Guided Pelvic Resections in Tumor Surgery, Alexander, John, H.; Mayerson, Joel, L.; Scharschmidt, Thomas, J. Techniques in Orthopaedics (Publish Ahead of Print)


Primary bone sarcoma of the pelvis is one of the more challenging pathologies treated by orthopedic oncologists. In particular, their anatomic complexity contributes to delays in diagnosis and high rates of positive margins with associated high rates of local recurrence, all contributing to poor outcomes in this patient population. Computer-assisted surgery in the form of navigation and patient-specific instrumentation has shown promise in other fields of orthopedics. Intuitively, in an effort to improve tumor resections and improve oncologic outcomes, surgeons have been working to apply these advances to orthopedic oncology. Early studies have demonstrated benefits from guided pelvic resections, with studies demonstrating improved resection accuracy, fewer positive margins and decreased rates of local recurrence. Although these techniques are promising and will likely become an essential tool for orthopedic oncologist, surgeons must understand the limitations and costs associated with each technology before blind adoption.

The preoperative computed tomography and magnetic resonance imaging were utilized to create a virtual resection plane and representative 3-dimensional model (3D Systems, Rock Hills, SC). A, Preoperative virtual 3-dimensional model of the sacral-based chondrosarcoma with the associated resection planes and planned postresection defect. B, Virtual representation of 3D-printed resection guides and their intraoperative placement. C, Stereolithographic 3D-printed pelvic model (3D Systems, Rock Hills, SC) made from a photopolymer resin with patient-specific sacral mass, vascular anatomy, and resection planes.