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Multidisciplinary Assessment of Planning and Resection of Complex Bone Tumor Using Patient-Specific 3D Model

  • Anil Murat Ozturk
  • Suzan Sirinturk
  • Levent Kucuk
  • Fulya Yaprak
  • Figen Govsa
  • Mehmet Asim Ozer
  • Ufuk Cagirici
  • Dundar Sabah
Original Article
  • 6 Downloads

Abstract

Oncological interventions in thoracic cavity have some important problems such as choice of correct operative approaches depending on the tumor, size, extension, and location. In sarcoma surgery, wide resection should be aimed for the curative surgery. Purpose of this study was to evaluate pre-operative planning of patient-specific thoracic cavity model made by multidisciplinary surgeon team for complex tumor mass for oncological procedures. Patient’s scans showed a large mass encroaching on the mediastinum and heart, with erosion of the adjacent ribs and vertebral column. Individual model of this case with thoracic tumor was reconstructed from the DICOM file of the CT data. Surgical team including six interdisciplinary surgeons explained their surgical experience of the use of 3D life-size individual model for guiding surgical treatment. Before patients consented to surgery, each surgeon explained the surgical procedure and perioperative risks to her. A questionnaire was applied to 10 surgical residents to evaluate the 3D model’s perception. 3D model scans were useful in determining the site of the lesion, the exact size, extension, attachment to the surrounding structures such as lung, aorta, vertebral column, or vascular involvement, the number of involved ribs, whether the diaphragm was involved also in which order surgeons in the team enter the surgery. 3D model’s perception was detected statistical significance as < 0.05. Viewing thoracic cavity with tumor model was more efficient than CT imaging. This case was surgically difficult as it included vital structures such as the mediastinal vessels, aorta, ribs, sternum, and vertebral bodies. A difficult pathology for which 3D model has already been explored to assist anatomic visualization was mediastinal osteosarcoma of the chest wall, diaphragm, and the vertebral column. The study helped to establish safe surgical line wherever the healthy tissue was retained and enabled osteotomy of the affected spinal corpus vertically with posterior-anterior direction by preserving the spinal cord and the spinal nerves above and distal the tumor. 3D tumor model helps to transfer complex anatomical information to surgeons, provide guidance in the pre-operative planning stage, for intra-operative navigation and for surgical collaboration purposes. Total radical excision of the bone tumor and reconstructions of remaining structures using life-size model was the key for successful treatment and better outcomes. The recent explosion in popularity of 3D printing is a testament to the promise of this technology and its profound utility in orthopedic oncological surgery.

Keywords

Osteosarcoma Thoracic neoplasms 3D printing model Preoperative planning Personalized medicine Orthopedic oncology, surgical specialties Computer-aided design 

Notes

Acknowledgments

Special thanks to Prof. Dr. Cemil Caliskan MD, Department of General Surgery and Dr. Serkan Ertugay MD, Department of Cardiovascular Surgery Faculty of Medicine, Ege University for sincere efforts and assistances.

Compliance with Ethical Standards

The study was approved by the suitably constituted Ethical Committee at Researches Department of Ege University (17-6/19), within which the work was undertaken, and the study conforms to the Declaration of Helsinki. The patient provided written informed consent.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Association of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Faculty of MedicineEge UniversityIzmirTurkey
  2. 2.Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of MedicineEge UniversityIzmirTurkey
  3. 3.Department of Thoracic Surgery, Faculty of MedicineEge UniversityIzmirTurkey

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