La navigazione nella chirurgia oncologica ortopedica: Applicazione ed implementazione di nuove tecnologie per il trattamento chirurgico dei tumori dell'apparato muscolo-scheletrico, studio pilota

In the present research project, from november 2011 to november 2013, patients with primary bone tumors of the extremities, pelvis and sacrum have been treated using computer assisted surgery evaluating the histological examination results of tumor resection margins and the clinical and radiological outcome. Materials and methods: We analized 16 patients 9 males and 7 females with a mean age of 31 years (range 12-55) and the primary bone tumors had different location, histology and grade. Of all the patients evaluated 8 had a localization to the lower limbs, 4 to the pelvis and 4 to the sacrum. Only those with parostale Osteosarcoma, Chordoma and Condrosarcoma have not been undergone to antiblastic treatment. Only one patients was subjected to postoperative radiotherapy for a local recurrence. All other patients were not treated with radiotherapy because of the adequacy of resection. There were no intraoperative complications. In the early postoperative period occured one neurological bladder, one sciatic paresis, two cases of infection one of which superficial and one deep; all the four patients with a sacral localizzation developed delayed wound healing and of these three developed sphincter incontinence. In all cases we obtained an excellent clinical and radiographic result, with patient satisfaction, proper contact between the osteotomy and the implant with a good stability to the first outpatient controls (FU 19 months). Results: Computer-assisted tumor surgery, with CT and MRI images fusion, has helped to improve the quality of the bone resections planned by the navigator and this may help reduce the risks of local recurrences. This technology is effective and useful for the treatment of musculoskeletal tumors, especially in complex anatomical sites like pelvis, sacrum and in intercalary resections and in all that cases where tumor resection could be difficult due to distorted surgical anatomy.