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Surgical inaccuracy of tumor resection and reconstruction within the pelvis: an experimental study.

Onglets principaux

Cartiaux, Olivier [UCL] Docquier, Pierre-Louis [UCL] Paul, Laurent [UCL] Francq, Bernard G. [UCL] Cornu, Olivier [UCL] Delloye, Christian [UCL] Raucent, Benoît [UCL] Dehez, Bruno [UCL] Banse, Xavier [UCL]

BACKGROUND AND PURPOSE: 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. INTERPRETATION: 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.

Type de document Article de périodique (Journal article) – Article de recherche
Type d'accès Accès restreint
Année de publication 2008
Information sur le périodique "Acta orthopaedica" - Vol. 79, no. 5, p. 695-702 (2008)
Peer reviewed oui
e-issn 1745-3682
issn 0001-6462
Statut de la publication Publié
Affiliations UCL - FSA/MECA - Département de mécanique
UCL - MD/CHIR - Département de chirurgie
UCL - FSA/ELEC - Département d'électricité
UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur
UCL - SSS/IREC/CARS - Computer Assisted Robotic Surgery
MESH Subject Bone Neoplasms - surgery ; Bone Transplantation ; Clinical Competence ; Computer Simulation ; Humans ; Models, Anatomic ; Models, Biological ; Osteosarcoma - surgery ; Pelvic Neoplasms - surgery ; Reconstructive Surgical Procedures - methods - standards
Liens
  1. Bell R S, J Bone Joint Surg (Am), 79, 1663 (1997)
  2. Delloye Christian, Pelvic Reconstruction with a Structural Pelvic Allograft After Resection of a Malignant Bone Tumor, 10.2106/jbjs.e.00943
  3. Dion N, J Bone Joint Surg (Am), 84, 644 (2002)
  4. Donati D., Surgical treatment and outcome of conventional pelvic chondrosarcoma, 10.1302/0301-620x.87b11.16621
  5. Enneking W F, J Bone Joint Surg (Am), 83, 971 (2001)
  6. Enneking W F, J Bone Joint Surg (Am), 60, 731 (1978)
  7. Enneking W F, J Bone Joint Surg (Am), 62, 1027 (1980)
  8. Fleiss Joseph L., Measuring nominal scale agreement among many raters., 10.1037/h0031619
  9. Fleiss Joseph L., Cohen Jacob, The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of Reliability, 10.1177/001316447303300309
  10. Friedlaender Gary E., Strong D. Michael, Tomford William W., Mankin Henry J., LONG-TERM FOLLOW-UP OF PATIENTS WITH OSTEOCHONDRAL ALLOGRAFTS, 10.1016/s0030-5898(05)70111-5
  11. Gautier Emanuel, B??chler Richard, Heini Paul F., Nolte Lutz P., Accuracy of Computer-Guided Screw Fixation of the Sacroiliac Joint : , 10.1097/00003086-200112000-00036
  12. Hillmann A., Hoffmann C., Gosheger G., R�dl R., Winkelmann W., Ozaki T., Tumors of the pelvis: complications after reconstruction, 10.1007/s00402-003-0543-7
  13. Hoffman David, Kringle Robert, TWO-SIDED TOLERANCE INTERVALS FOR BALANCED AND UNBALANCED RANDOM EFFECTS MODELS, 10.1081/bip-200048826
  14. Hornicek Francis J., Gebhardt Mark C., Tomford William W., Sorger Joel I., Zavatta Marcello, Menzner Jeffry P., Mankin Henry J., Factors Affecting Nonunion of the Allograft-Host Junction : , 10.1097/00003086-200101000-00014
  15. Hüfner T., Pohlemann T., Tarte S., Gänsslen A., Citak M., Bazak N., Culemann U., Nolte L. P., Rrettek C., Computer-Assisted Fracture Reduction: Novel Method for Analysis of Accuracy, 10.3109/10929080109146001
  16. H??fner T., Pohlemann T., Tarte S., G??nsslen A., Geerling J., Bazak N., Citak M., Nolte L. P., Krettek C., Computer-Assisted Fracture Reduction of Pelvic Ring Fractures: An In Vitro Study : , 10.1097/00003086-200206000-00028
  17. H??fner Tobias, Kfuri Maur??cio, Galanski Michael, Bastian Leonard, Loss Martin, Pohlemann Tim, Krettek Christian, New Indications for Computer-Assisted Surgery : Tumor Resection in the Pelvis, 10.1097/01.blo.0000138958.11939.94
  18. Kawaguchi Noriyoshi, Matumoto Seiichi, Manabe Jun, New method of evaluating the surgical margin and safety margin for musculoskeletal sarcoma, analysed on the basis of 457 surgical cases, 10.1007/bf01197769
  19. Krettek Christian, Geerling Jens, Bastian Leonard, Citak Musa, Rücker Ferdinand, Kendoff Daniel, Hüfner Tobias, Computer aided tumor resection in the pelvis, 10.1016/j.injury.2004.05.014
  20. Langlotz Frank, B??chler Richard, Berlemann Ulrich, Nolte Lutz-Peter, Ganz Reinhold, Computer Assistance for Pelvic Osteotomies : , 10.1097/00003086-199809000-00012
  21. Mankin Henry J, Hornicek Francis J, Raskin Kevin A, Infection in Massive Bone Allografts : , 10.1097/01.blo.0000150371.77314.52
  22. Ortiz-Cruz E, J Bone Joint Surg (Am), 79, 97 (1997)
  23. Petrie A., Statistics in orthopaedic papers, 10.1302/0301-620x.88b9.17896
  24. Pring M E, J Bone Joint Surg (Am), 83, 1630 (2001)
  25. Sorger Joel I., Hornicek Francis J., Zavatta Marcello, Menzner Jeffry P., Gebhardt Mark C., Tomford William W., Mankin Henry J., Allograft Fractures Revisited : , 10.1097/00003086-200101000-00011
  26. Thompson Roby C., Garg Ashima, Clohisy Denis R., Cheng Edward Y., Fractures in Large Segment Allografts : , 10.1097/00003086-200001000-00023
  27. van Hellemondt G., de Kleuver M., Kerckhaert A., Anderson P., Langlotz F., Nolte L. P., Pavlov P. W., Computer-Assisted Pelvic Surgery : An In Vitro Study of Two Registration Protocols, 10.1097/00003086-200212000-00036
  28. Weber Kristy L., Pring Maya E., Sim Franklin H., Treatment and Outcome of Recurrent Pelvic Chondrosarcoma : , 10.1097/00003086-200204000-00004
  29. Wheeler Donna L, Enneking William F, Allograft Bone Decreases in Strength In Vivo over Time : , 10.1097/01.blo.0000165850.58583.50
Référence bibliographique Cartiaux, Olivier ; Docquier, Pierre-Louis ; Paul, Laurent ; Francq, Bernard G. ; Cornu, Olivier ; et. al. Surgical inaccuracy of tumor resection and reconstruction within the pelvis: an experimental study.. In: Acta orthopaedica, Vol. 79, no. 5, p. 695-702 (2008)
Permalien http://hdl.handle.net/2078.1/19627