Prospective study on image‐guided navigation surgery for pelvic malignancies

• Published in: Journal of surgical oncology Vol. 119; no. 4; pp. 510 - 517
• Main Authors: Nijkamp, Jasper, Kuhlmann, Koert F. D., Ivashchenko, Oleksandra, Pouw, Bas, Hoetjes, Nikie, Lindenberg, Melanie A., Aalbers, Arend G. J., Beets, Geerard L., Coevorden, Frits, KoK, Niels, Ruers, Theo J. M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2019
• Subjects: Cancer surgery; CAS; Colorectal cancer; Computer assisted surgery; electromagnetic tracking; Humans; Imaging, Three-Dimensional; locally advanced rectal cancer; Lymph Node Excision; Lymphatic system; Patients; Pelvic Neoplasms - diagnostic imaging; Pelvic Neoplasms - surgery; pelvic recurrences; Prospective Studies; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; surgical navigation; Tomography, X-Ray Computed; surgical navigation; pelvic recurrences; electromagnetic tracking; locally advanced rectal cancer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25351

Background and objectives Surgery of advanced tumors and lymph nodes in the pelvis can be challenging due to the narrow pelvic space and vital surrounding structures. This study explores the application of a novel electromagnetic navigation system to guide pelvic surgery. Methods This was a prospective study on surgery for malignancies in the pelvis. Preoperatively obtained imaging was used to create a patient‐specific three‐dimensional (3D) roadmap. In the operating room, the 3D roadmap was registered to an intraoperative computed tomography scan. A tracked pointer was used during surgery for guidance. Primary endpoint was safety and feasibility, secondary endpoints were accuracy and usability. Results Twenty‐eight colorectal, four liposarcomas, and one gynecological patient were included. There were no safety issues. Navigation was feasible in 31 patients. The mean target registration errors of 4.0 and 6.3 mm were achieved for straight and French position, respectively. In seven of seven patients with a locally advanced rectal tumor and in seven of eight patients with recurrences, negative margins were achieved. Thirty‐three of 36 target lymph nodes were successfully removed. Surgeons using the system indicated faster localization of the tumor and improved decisiveness. Conclusion This novel surgical navigation system was safe and feasible during pelvic surgery and can facilitate its users.