Accurate 3-dimensional Preoperative Planning and Resection in Orthopedic Oncology

Abstract

Currently, most patients with a sarcoma in an extremity are treated with a limb salvage surgery. The surgeon must determine, with the highest precision, where the bone and soft tissue should be cut to preserve as much unaffected tissue without invading tumor margins. Many times the surgeon finds, after studying the resected specimen, that margins were too wide, jeopardizing durability of the reconstruction. Other times, inaccuracy of planning or execution of the tumor resection shows violation of tumor margins, worsening patients’ life prognoses. Most preoperative plans are made using biplanes images of the lesion obtained with computed tomography or magnetic resonance imaging (MRI) studies. In addition, intraoperatively the surgeon must rely on images hanging in the operation room, visually incorporate them, and manually perform what he or she considers appropriate margins according to a cerebral elaborated execution. This mental integration of preoperative 2-dimensional image information into a 3-dimensional intraoperative surgical situation may lead to an inaccurate execution. Many surgeons would call this experience, but it is based in a painful learning curve for patients and surgeons. Even the most experienced oncologic surgeons could find themselves in an unexpected situation when evaluating the resected specimen. This is particularly true in tumors growing in the pelvis, spine, groin, shoulder, popliteal fossae, or any other place in which the surgeon must resect as minimal an amount of tissues possible and preserve safe tumor margins. However, recent advances in computerized techniques applied to orthopedic oncology surgery may significantly influence our accuracy and