Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions.

Daniel Schmermund,Christina Bäcker,Hans-Peter Howaldt,Sameh Attia,Sebastian Böttger,Philipp Streckbein,Michael Knitschke

doi:10.3390/cancers13123013

Abstract

Simple SummaryComputer-aided design and manufacturing of osseous reconstructions are currently widely used in jaw reconstructive surgery, providing an improved surgical outcome and decreased procedural stumbling block. However, data on the influence of planning time on the time-to-surgery initiation and resection margin are missing in the literature. This retrospective, monocentric study compares process times from the first patient contact in hospital, time of in-house or out-of-house biopsy for tumor diagnosis and surgical therapy of tumor resection, and immediate reconstruction of the jaw with free fibula flaps (FFF). Two techniques for reconstruction are used: Virtual surgical planning (VSP) and non-VSP. A total of 104 patients who underwent FFF surgery for immediate jaw reconstruction from 2002 to 2020 are included. The study findings fill the gaps in the literature and obtain clear insights based on the investigated study subjects. Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.

Highlights

Oral squamous cell cancer (OSCC) is the most common malignancy of the upper aerodigestive tract, with about 90–95% prevalence [1,2]
Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery
Secondary reconstruction after tumor recurrence or delayed jaw reconstruction with free fibula flap (FFF), as well as cases in which flaps other than FFF had been used, were excluded from this investigation

Summary

Introduction

Oral squamous cell cancer (OSCC) is the most common malignancy of the upper aerodigestive tract, with about 90–95% prevalence [1,2]. Surgical therapy is aimed to excise the neoplasia with a surrounding safety margin of ≥5 mm (R0-resection) [9], corresponding to an intraoral distance of 10 mm to the palpable tumor border [10]. The margin of excision was defined as close when the distance to the tumor border was between 1–5 mm [12,13]. The involved margin (R1-resection) was described when the distance from the tumor border to the margin of excision was less than 1 mm. Reported disadvantages of VSP are planning time [35], preparation time, and cost aspects, which must be considered [36] as patient-specific (laser-melted titanium) implants are expensive and will decrease the gain on total proceeds

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