Computer-Assisted Pelvic Tumor Resection: Fields of Application, Limits, and Perspectives
The treatment of malignant tumors involving the pelvic area is a challenging problem in musculoskeletal oncology due to the complex pelvic anatomy and the often large tumor size at presentation. The use of navigation systems has effectively increased surg
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Sebastian Fehlberg, Sebastian Eulenstein, Thomas Lange, Dimosthenis Andreou, and Per-Ulf Tunn
Abstract The treatment of malignant tumors involving the pelvic area is a challenging problem in musculoskeletal oncology due to the complex pelvic anatomy and the often large tumor size at presentation. The use of navigation systems has effectively increased surgical precision aiming at optimal preservation of pelvic structures without compromising oncologic outcome by means of improved visibility of the surgical field, and enabling intraoperative display and 3D reproduction of preoperatively determined pelvic osteotomy and resection levels. In the following sections, current developments in computer-assisted pelvic surgery are reviewed and possible fields of application, as well as limitations of navigation systems, are discussed.
Sebastian Fehlberg (*) Department of Orthopedic Oncology Sarkomzentrum Berlin-Brandenburg Helios Klinikum Berlin-Buch Schwanebecker Chaussee 50 13125 Berlin, Germany E-mail: [email protected]
11.1 Introduction Tumors involving the pelvic area represent one of the most difficult challenges in musculoskeletal oncology. Approximately 6% – 15% of all primary malignant bone tumors involve the pelvis (Price and Jeffree 1977; Campanacci and Capanna 1991); chondrosarcoma, osteosarcoma, and Ewing’s sarcoma are the most common diagnoses (Bacci et al. 2003; Ozaki et al. 2003a, b; Pring et al. 2001). The bony pelvis is also a frequent site of metastasis for numerous other malignancies, including kidney, prostate, breast, lung, thyroid, and bladder carcinomas (Wingo et al. 1995; Yasko et al. 2007). Pelvic bone tumors are often large at presentation and can invade important anatomical structures, including the iliac vessels, the femoral and sciatic nerve, or the pelvic viscera. Furthermore, tumors of the iliac bone can invade the sacral bone and the sacral nerve roots (Ozaki et al. 2003a, b; Court et al. 2006). Multimodal approaches for the treatment of primary malignant pelvic bone tumors include resection with
Per-Ulf Tunn (Ed.), Treatment of Bone and Soft Tissue Sarcomas. Recent Results in Cancer Research 179, DOI: 10.1007/978-3-540-77960-5, © Springer-Verlag Berlin Heidelberg 2009
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clear surgical margins, if necessary with medial surgical margin extension into the sacrum, in order to reduce local recurrence rates and improve overall survival (Yang et al. 1995; Kawai et al. 1998a, b; Kollender et al. 2000; Sucato et al. 2000). In recent years, an increasing number of patients are being treated with limb-salvage surgery rather than mutilating procedures (Pant et al. 2001; Tunn et al. 2003), aiming at an improved function and quality of life without compromising the quality of surgical margins (Ozaki et al. 2003a, b; Kollender et al. 2000; Wirbel et al. 2001; Pring et al. 2001; Hoffmann et al. 2006). However, the demanding threedimensional (3D) configuration of the pelvic anatomy, tumor size, structural alterations following neoadjuvant treatment, lack of experienc
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