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Automated dangerous region generation for computer-assisted pelvic bone tumour resection: a retrospective comparative
Daming Pang1, Zeyi Song1, Yibo Liu1
1Department of Orthopaedic Oncology, Affiliated Beijing jishuitan Hospital of Capital Medical University, Beijing, China.
Background:
Computer-assisted navigation improves spatial orientation during pelvic bone tumour resection but provides no direct three-dimensional feedback regarding the distance between the tumour and planned osteotomy planes. This study evaluated the clinical value of automated dangerous region generation (ADRG) as an adjunct to computer-assisted surgery.
Methods:
We retrospectively analyzed 32 patients with pelvic bone tumours treated between May 2018 and February 2025. Sixteen underwent resection using automated dangerous region generation combined with computer-assisted surgery (ADRG + CAS group), and 16 underwent computer-assisted surgery alone (CAS-only group). Perioperative, oncological, survival, and functional outcomes were compared.
Results:
Median operative time was shorter in the ADRG + CAS group than in the CAS-only group [212.5 min (161.3-325.0) vs 355.0 min (267.8-405.0); p = 0.013]. Median intraoperative blood loss was also lower [1,100 mL (850-1,475) vs 1,550 mL (1,050-2,750); p = 0.040]. Length of stay did not differ significantly [18.0 days (16.0-29.8) vs 17.0 days (14.3-22.0); p = 0.161]. Local recurrence occurred in no patient in the ADRG + CAS group and in three patients in the CAS-only group. Metastasis occurred in two and three patients, respectively, and two patients in each group died. Wide surgical margins were obtained in 14/16 (87.5%) patients in the ADRG + CAS group versus 12/16 (75.0%) in the CAS-only group, while marginal surgical margins were obtained in 2/16 (12.5%) versus 4/16 (25.0%), respectively; no intralesional margins were recorded (p = 0.654). The estimated two year overall survival (OS) rate was 93.8% (95% CI, 63.3%-99.1%) in both groups (log-rank p = 0.986). The estimated two year progression-free survival (PFS) rates were 87.5% (95% CI, 58.6%-96.7%) in the ADRG + CAS group and 81.3% (95% CI, 52.5%-93.6%) in the CAS-only group (log-rank p = 0.633). Functional outcomes were comparable (p = 0.157).
Conclusions:
In this retrospective cohort, the ADRG + CAS group had a shorter operative time and lower intraoperative blood loss than the CAS-only group, and wide surgical margins were achieved in most patients receiving ADRG + CAS. ADRG may be a useful adjunct to CAS for surgical margin planning in complex pelvic bone tumour resection.