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Navigation-guided resection of locally advanced midface malignancies. Does it improve the safety of oncologic
Álvaro Ranz-Colio1, Fernando Almeida-Parra2, Patricia De Leyva-Moreno2
1Oral and Maxillofacial Surgeon in Ramon y Cajal University Hospital, Madrid, Spain; Puerta de Hierro University Hospital, Majadahonda, Spain; University of Alcala de Henares, Madrid, Spain.
Introduction:
Treatment of malignant midface tumors is a surgical challenge with an increased difficulty to obtain free surgical margins. The computer assisted surgery (CAS) and intraoperative navigation (ION) can be very helpful in complex midface resections. The main objective of this paper is to evaluate if the ION could improve the rate of free surgical margins in locally advanced midface malignancies.
Materials And Methods:
A retrospective cohort study was performed including 40 patients with a locally advanced malignant midface tumor (T4a/b) surgically treated from September 2016 to September 2022. Patients were divided in two groups, a control group included 20 patients operated on without ION and the study group included 20 patients treated with Navigation assisted surgery. A systematic analysis was performed comparing surgical margins in both groups.
Results:
Squamous cell carcinoma was the most common histological type. Oral cavity was the most common primary location. Overall, considering each specimen as an hexahedrium, 240 surgical margins were analyzed. 15 out of 120 margins analyzed in the navigation group (12.5 %) were positive while 30 out of 120 margins analyzed in control group (25 %) were affected (p 0.013). Concerning margin location, the ION group showed less involvement of the upper surface of specimen than in control group (p 0.048).
Conclusion:
Navigation Assisted Surgery seems to improve the rate of free surgical margins in patients with locally advanced midface malignancies, specially concerning involvement of the superior margin. Further studies are recommended to corroborate these results and its potential influence in survival rates.
Insights
Navigation assisted surgery (ION) significantly improved free surgical margins for advanced midface tumors. This technique reduced positive margins, especially on the superior aspect, aiding oncologic resection.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Technology
Background:
- Malignant midface tumors present surgical challenges, particularly in achieving free surgical margins.
- Computer-assisted surgery (CAS) and intraoperative navigation (ION) offer potential benefits in complex midface resections.
Purpose of the Study:
- To evaluate if intraoperative navigation (ION) can enhance the rate of free surgical margins in patients with locally advanced midface malignancies.
Main Methods:
- A retrospective cohort study included 40 patients with locally advanced malignant midface tumors (T4a/b).
- Patients were divided into two groups: 20 operated on without ION (control) and 20 with ION-assisted surgery.
- A systematic analysis compared surgical margins between the two groups.
Main Results:
- ION-assisted surgery resulted in a lower percentage of positive surgical margins (12.5%) compared to the control group (25%) (p=0.013).
- The ION group demonstrated significantly less involvement of the superior specimen surface (p=0.048).
- Squamous cell carcinoma was the most common histological type, with the oral cavity being the most frequent primary location.
Conclusions:
- Navigation-assisted surgery appears to improve the rate of free surgical margins in locally advanced midface malignancies.
- ION is particularly effective in reducing superior margin involvement.
- Further research is recommended to confirm these findings and assess their impact on patient survival rates.
