Long-term outcomes of computer-navigation assisted geographic resection for primary bone tumors in lower extremities - when less is more

Abstract

Abstract Objectives The aim of this study was to to investigate the outcomes of geographic resections with computer navigation for treatment of bone tumors in lower extremities. Methods A retrospective cohort analysis was conducted on 51 patients who underwent computer-navigation assisted (25 cases) and free-hand (26 cases) geographic resections of bone tumors in lower extremities between September 2010 and Feburary 2022. All patients’ bone defects were reconstructed by allograft bones. The oncological outcomes, functional outcomes, resection accuracy and complications were compared between these two groups in this study.The oncological outcomes comparasion included the local control,metastasis and 3-year and 5-year overall survival differences between the navigation-assisted (NA) group and the free-hand (FH) group. The oncological outcomes were evaluated by Musculoskeletal Tumor Society (MSTS) scores. The resection accuracy was evaluated by indicators such as the major-axis length,the minor-axis length and maximal gap. The resection error (RE) was defined as the resected specimen length minus the planned resection length and were compared between the two groups. The maximal gap error (MGE) was defined as the length between the margin of allograft bones and the host bones at the bone cutting sites. Results 51 consecutive patients was included in this retrosepective cohort and there were no patients lost in the follow-up period. The mean follow-up time was 93.76+38.49 (22-179) months. No navigation-related surgical complications were observed. The resection errors between the postoperative specimen length and the preoperative planned length were compared to evaluate the resection accuracy after surgery. In the navigation group, the resected errors of the long axis, short axis and depth were 1.760±1.109 (-3.9 to 3.8) mm, 1.32±0.571 (-2.3 to 2.3) mm and 1.58±0.360 (-2.1 to 2.3) mm in the navigation group and 3.67±1.829 (-4.2 to 3.4) mm, 4.61±2.488 (-9.4 to 10.4) mm and 4.21±1.902 (-7.1 to 9.5) mm in the free-hand group, respectively(p<0.001). While the comparasion of oncological, functional outcomes and complications between the groups didn’t show statistical difference (p>0.05). Conclusions These resection accuracy of computer-navigation assisted surgery is better than free-hand group for bone tumors in lower extremities, and does not affect the oncological outcomes, functional outcomes and complications compared to the control group. Level of evidence: level III Therapeutic.