Selecting Image-Guided Surgical Technologies in Oncology: A Surgeon's Perspective

Area of Science:

• Surgical Oncology
• Medical Technology Assessment
• Health Services Research

Background:

• Image-guided (IG) technologies are increasingly used to improve surgical performance.
• The optimal application of IG technologies across various oncologic procedures remains unclear.
• This study aimed to identify the most valuable IG technology for each oncologic indication.

Purpose of the Study:

• To evaluate and rank three image-guided technologies (navigation, optical imaging, augmented reality) for five oncologic indications.
• To determine the most promising IG technology for specific oncologic procedures based on surgeon preferences and predefined criteria.
• To guide future research, development, and clinical implementation of IG technologies in cancer surgery.

Main Methods:

• An Analytic Hierarchical Process (AHP) was employed to assess IG technologies against usual care.
• Sixteen decision criteria, including sparing critical tissue and reducing local recurrence, were evaluated.
• Surgeons rated the importance of criteria and the performance of navigation, optical imaging, and augmented reality technologies.

Main Results:

• Sparing critical tissue (9%-18%) and reducing local recurrence risk (11%-27%) were the most critical decision criteria.
• Navigation technology was preferred for lymph node (42%), liver (47%), and rectal tumor (33%) removal.
• Optical imaging was equally preferred for rectal tumor removal (34%); no single technology dominated for breast or tongue tumors.

Conclusions:

• Optical and navigation IG technologies are expected to provide significant value beyond usual care in selected oncologic procedures.
• Further development of these technologies for specific indications, such as rectal tumor removal, is warranted.
• Multi-attribute analysis effectively prioritized clinical studies and directed research and development efforts for IG surgical technologies.