Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
Eur J Surg Oncol. 2021 Feb;47(2):416-423. doi: 10.1016/j.ejso.2020.05.025. Epub 2020 Jul 3.
Survival in patients with chondrosarcomas has not improved over 40 years. Although emerging evidence has documented the efficacy of navigation-assisted surgery, the prognostic significance in chondrosarcomas remains unknown. We aimed to assess the clinical benefit of navigation-assisted surgery for pelvic chondrosarcomas involving the peri-acetabulum.
We studied 50 patients who underwent limb-sparing surgery for periacetabular chondrosarcomas performed with navigation (n = 13) without it (n = 37) at a referral musculoskeletal oncology centre between 2000 and 2015.
The intralesional resection rates in the navigated and non-navigated groups were 8% (n = 1) and 19% (n = 7), respectively; all bone resection margins were clear in the navigated group. The 5-year cumulative incidence of local recurrence was 23% and 56% in the navigated and non-navigated groups, respectively (p = 0.035). There were no intra-operative complications related to use of navigation. There was a trend toward better functional outcomes in the navigated group (mean MSTS score, 67%) than the non-navigated group (mean MSTS score, 60%; p = 0.412). At a mean follow-up of 63 months, the 5-year disease-specific survival was 76% and 53% in the navigated and non-navigated group, respectively (p = 0.085), whilst the 5-year progression-free survival was 62% and 28% in the navigated and non-navigated group, respectively (p = 0.032).
This study confirmed improved local control and progression-free survival with the use of computer navigation in patients with limb-salvage surgery for periacetabular chondrosarcomas, although the advancement in other treatment modalities is required for improvement of disease-specific survival.
软骨肉瘤患者的生存率在 40 多年来并未得到改善。尽管新出现的证据已经证明了导航辅助手术的疗效，但在软骨肉瘤中其预后意义尚不清楚。我们旨在评估导航辅助手术在涉及髋臼周围的骨盆软骨肉瘤患者中的临床获益。
我们研究了 2000 年至 2015 年间，在一家转诊肌肉骨骼肿瘤中心接受保肢手术治疗髋臼周围软骨肉瘤的 50 名患者，其中 13 名患者接受了导航辅助手术（导航组），37 名患者未接受导航辅助手术（非导航组）。
导航组和非导航组的肿瘤内切除术率分别为 8%（n=1）和 19%（n=7）；导航组所有骨切缘均清晰。导航组和非导航组的 5 年局部复发累积发生率分别为 23%和 56%（p=0.035）。导航使用过程中无手术相关并发症。导航组的功能结局（MSTS 评分均值为 67%）优于非导航组（MSTS 评分均值为 60%；p=0.412），这一结果存在趋势。在平均随访 63 个月时，导航组和非导航组的 5 年疾病特异性生存率分别为 76%和 53%（p=0.085），5 年无进展生存率分别为 62%和 28%（p=0.032）。
本研究证实，在髋臼周围软骨肉瘤保肢手术中使用计算机导航可提高局部控制率和无进展生存率，但需要改进其他治疗方法来提高疾病特异性生存率。
