Surgical inaccuracy of tumor resection and reconstruction within the pelvis: an experimental study.
OBJECTIVE
Osseous pelvic tumors can be resected and reconstructed using massive bone allografts. Geometric accuracy of the conventional surgical procedure has not yet been documented. The aim of this experimental study was mainly to assess accuracy of tumoral resection with a 10-mm surgical margin, and also to evaluate the geometry of the host-graft reconstruction.


METHODS
An experimental model on plastic pelvises was designed to simulate tumor resection and reconstruction. 4 experienced surgeons were asked to resect 3 different tumors and to reconstruct pelvises. 24 resections and host-graft junctions were available for evaluation. Resection margins were measured. Several methods were created to evaluate geometric properties of the host-graft junction.


RESULTS
The probability of a surgeon obtaining a 10-mm surgical margin with a 5-mm tolerance above or below, was 52% (95% CI: 37-67). Maximal gap, gap volume, and mean gap between host and graft was 3.3 (SD 1.9) mm, 2.7 (SD 2.1) cm3 and 3.2 (SD 2.1) mm, respectively. Correlation between these 3 reconstruction measures and the degree of contact at the host-graft junction was poor.


CONCLUSIONS
4 experienced surgeons did not manage to consistently respect a fixed surgical margin under ideal working conditions. The complex 3-dimensional architecture of the pelvis would mainly explain this inaccuracy. Solutions to this might be to increase the surgical margin or to use computer- and robotic-assisted technologies in pelvic tumor resection. Furthermore, our attempt to evaluate geometry of the pelvic reconstruction using simple parameters was not satisfactory. We believe that there is a need to define new standards of evaluation.
Cartiaux
Olivier
O
Center for Research in Mechatronics, Universite catholique de Louvain, Louvain-la-Neuve, Belgium. olivier.cartiaux@uclouvain.be
Docquier
Pierre-Louis
PL
Paul
Laurent
L
Francq
Bernard G
BG
Cornu
Olivier H
OH
Delloye
Christian
C
Raucent
Benoit
B
Dehez
Bruno
B
Banse
Xavier
X
D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D008953:Models, Anatomic; D008954:Models, Biological; D012516:Osteosarcoma / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000592:standards