P43.01 Three-Dimensional Virtual Planning for Nodule Resection in Solid Organs: A Systematic Review and Meta-Analysis

Abstract

The use of preoperative information support is an asset to assist surgeons during challenging procedures. Studies on image-guided surgery (IGS) must be encouraged to guarantee proper usage of these post-processing technologies, which are the manipulation of radiographic images to achieve further qualitative or quantitative data. IGS systems could improve intraoperative orientation, identification, and location of anatomical structures and their variations, decreasing surgeon’s workload and contribute to performance enhancement. This study aimed to assess the effects of three-dimensional (3D)-imaging virtual planning (3DVP) for nodule resection in the following solid organs: lung, liver, and kidney. Databases (MEDLINE, EMBASE, and Cochrane Library) were searched through 31st December 2020 to include randomized and non-randomized controlled studies that compared outcomes of surgical resection of lung, liver, or kidney nodule resection with and without 3D virtual planning with computed tomography. From each article, mean operation time (OT), mean estimated blood loss (EBL), mean postoperative hospital stay (POHS), and the number of postoperative events (POE) were extracted. The effect size (ES) of 3D virtual planning vs. non-3D planning was extracted from each study to calculate the pooled measurements for continuous variables (OT, EBL, POHS), being also calculated a general ES from all studies for OT, EBL, and POHS. Data were pooled using a random-effects model. Heterogeneity between studies was tested with the Q-test, and the quantity of its extent with I2 index. All P-values less than 0.005 were considered statistically significant. The literature search yielded 2397 studies, from which 86 were reviewed, and 10 met the inclusion criteria. From these ten articles, the main site of operation was the lungs in two, the liver in three, and the kidney in five. Were included 897 patients, from which 469 (52.3%) had undergone 3DVP, and 428 (47.7%) were non-3DPV controls. There was a significant difference in OT between groups with a moderate ES favoring the 3D group (ES: -0.42; 95%CI: -0.56, -0.29; I2= 83.1%; p<0.001). Regarding EBL, there was a significant difference between 3D and non-3D with a small ES favoring IGS (ES: -0.15; 95%CI: -0.28 - 0.02; I2=22.5%; p=0.0236). There was no difference between the 3D and non-3D groups for both POHS (ES: -0.01; 95%CI: -0.19,0.17; I2=0.0%; p=0.925) and POE (odds ratio (OR): 0.80; 95%CI: 0.54,1.19; I2=0.0%; p=0.267). 3D-imaging planning for surgical resection of lung, liver, and kidney nodules could significantly reduce OT and EBL with no effects on immediate POHS and POE. Although immediate perioperative results (POHS and POE) had not shown a significant difference between groups, any improvements in OT and EBL could positively influence medium and long-term postoperative clinical outcomes, lowering rates of surgical site infections, for instance, due to reduced OT.