Guler Ezgi, Ozer Mehmet Asim, Bati Ayse Hilal, Govsa Figen, Erozkan Kamil, Vatansever Safa, Ersin Muhtar Sinan, Elmas Nevra Zehra
Department of Radiology, Ege University Faculty of Medicine, Turkey.
Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Ege University Faculty of Medicine, Turkey.
Surg Oncol. 2021 Jun;37:101537. doi: 10.1016/j.suronc.2021.101537. Epub 2021 Mar 5.
A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery.
This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage.
All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful.
With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.
器官切除术肿瘤外科手术规划的一个基本方面是识别供血血管细节，以在完全切除肿瘤的同时保留健康的器官组织。本研究的目的是确定计算机断层扫描（CT）图像的三维（3D）癌症病例模型是否有助于住院医师水平的学员制定合适的器官切除手术计划。
本研究基于向手术住院医师展示5种不同肿瘤外科手术场景后的认知。为此研究构建了一个包含肝脏肿物、胃部肿物、环状胰腺、盆腔肿物和纵隔肿物病例的五站式旋转台。要求住院医师在识别肿物侵犯情况、进行鉴别诊断和术前规划阶段，将他们对病例的认知水平与CT图像及3D模型进行比较。
所有住院医师对模型给出了更高的评分。3D模型能更好地理解肿瘤病理解剖结构并改进手术规划。在所有场景中，70 - 80%的住院医师在术前规划时更倾向于使用模型。对于手术选择，与CT相比，模型在视觉评估方面（如肿瘤位置、远端或近端器官切开）提供了具有统计学意义的差异（p:0.009）。在评估骶前肿物时，模型在软骨肉瘤的骨孔关系、起源、几何形状、定位、侵犯及手术偏好方面的认知明显优于CT（p:0.004）。模型在与进行手术的同事一起评估和准备病例方面在统计学上显著提供了帮助（p:0.007）。在对开放性问题的评论中，他们表示3D模型中肿瘤与血管的关系清晰可见，非常有用。
借助本研究中的3D打印技术，在癌症手术培训中实施和评估结构良好的真实患者场景设置成为可能。它可用于增进对多学科肿瘤病例病理解剖变化的理解。也就是说，它用于指导手术策略并确定特定患者的3D模型是否会改变外科医生在复杂癌症肿物手术过程中做出的术前规划决策。
