title: Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones.
abstract: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors. Segmental resection has been recommended for these tumors in the bones because curettage was found to be associated with a high local recurrence rate. Navigation-assisted surgery provides radiological information to guide the surgeon during surgery. No previous study has reported on the efficacy of navigation-assisted surgery for tumors in patients with TIO. Therefore, the present study aimed to evaluate the efficacy of navigation-assisted surgery for tumors in patients with TIO.
  
  
  
  The study included seven patients with TIO who were treated between January 2003 and December 2014 at our hospital. All patients underwent surgical treatment with or without the use of a 3-dimensional (3D) fluoroscopy-based navigation system. The laboratory data and oncological outcomes were evaluated.
  
  
  
  The follow-up period was 8-128 months. The tumors were located at the femur (n = 4), ischium, spine and ilium (n = 1). Of the seven patients, five underwent navigation-assisted surgery and two underwent surgery without navigation assistance. In the two patients who underwent surgery without navigation assistance, a complete cure was not obtained and osteomalacia did not resolve. One of these two patients and the other five patients who underwent navigation-assisted surgery, one patient had incomplete resection due to massive invasion of the tumor into the spinal canal, but five patients achieved complete excision and recovered from osteomalacia.
  
  
  
  Navigation-assisted surgery using a 3D fluoroscopy-based navigation system is effective for tumors in patients with TIO.
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.|b Department of Orthopaedic Surgery , Saitama Medical Center, Jichi Medical University , Saitama , Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.
authors.forename: Tomotake
authors.initials: T
authors.lastname: Okuma
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shinoda
authors.affiliation: c Department of Medical Research and Management for Musculoskeletal Pain , 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: d Department of Nephrology and Endocrinology, Faculty of Medicine , University of Tokyo , Tokyo , Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Ito
authors.affiliation: d Department of Nephrology and Endocrinology, Faculty of Medicine , University of Tokyo , Tokyo , Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Fukumoto
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan.|e Department of Orthopaedic Surgery, Faculty of Medicine , University of Teikyo , Tokyo , Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kawano
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005269:Femur; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium; D021621:Imaging, Three-Dimensional; D007512:Ischium; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010018:Osteomalacia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010257:Paraneoplastic Syndromes; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors
keywords: 3D fluoroscopy-based navigation system; Bayesian estimation; Word; curettage; tumor-induced osteomalacia