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Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study
Marco Ferrari1, Michael J Daly2, Catriona M Douglas3
1Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
Objectives:
To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer.
Materials And Methods:
Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared.
Results:
The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001).
Conclusion:
This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
Insights
Three-dimensional (3D) navigation significantly improves surgical margin control for sinonasal cancer surgery. This preclinical study shows 3D guidance eliminates intratumoral cuts, enhancing safety in ablative open surgery.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Computer-Assisted Surgery
Background:
- Advanced sinonasal cancer presents challenges in achieving adequate surgical margins.
- Precise margin delineation is critical for successful ablative open surgery and oncological outcomes.
- Current surgical techniques may lack the precision needed for complex tumor resections.
Purpose of the Study:
- To evaluate the efficacy of three-dimensional (3D) navigation guidance in improving margin delineation during simulated ablative open surgery for sinonasal cancer.
- To quantify the benefits of 3D navigation in achieving clear surgical margins in a preclinical setting.
Main Methods:
- Seven sinonasal tumor models were utilized with cone beam computed tomography (CBCT) for 3D imaging.
- Eight surgeons performed simulated osteotomies using unguided, tumor-guided, and margin-guided 3D navigation techniques.
- Cutting planes were analyzed to determine the distance from the tumor surface, categorizing margins as intratumoral, close, adequate, or excessive.
Main Results:
- Three-dimensional (3D) navigation significantly enhanced margin control compared to unguided surgery.
- Unguided cuts resulted in 18.1% intratumoral margins, while 3D navigation achieved 0% intratumoral margins (p < 0.0001).
- Margin-guided 3D navigation demonstrated superior precision in delineating surgical margins.
Conclusions:
- This preclinical study confirms the substantial benefit of 3D navigation-guided osteotomies for sinonasal tumors.
- The findings support the translation of this technology into clinical practice for improved surgical precision.
- Further clinical assessment of oncological outcomes is recommended to validate these preclinical findings.
