Patient-specific guides for consistently achieving R0 bone margins after resection of primary malignant bone tumors of the pelvis

Abstract

Abstract Aims Primary malignant bone tumor of the pelvis is an uncommon lesion, the resection of which via freehand osteotomy is subject to inaccuracy due to its three-dimensional anatomy. Patient-Specific Guides (PSG), also called Patient-Specific Instruments (PSI) are essential to ensure surgical planning and resection adequacy. Our aim was to assess their use and effectiveness. Methods A monocentric retrospective study was conducted on 42 adult patients who underwent PSG-based resection of a primary malignant bone tumor of the pelvis. The primary outcome was the proportion of R0 bone margins. The secondary outcomes were the proportion of overall R0 margins, considering soft-tissue resection, the cumulative incidence of local recurrence, and the time of production for the guides. A comparison to a previous series at our institution was performed regarding histological margins. Results Using PSGs, 100% R0 safe bone margin was achieved, and 88% overall R0 margin due to soft-tissue resection being contaminated, while the comparison to the previous series showed only 80% of R0 safe bone margin. The cumulative incidences of local recurrence were 10% (95% CI: 4–20%) at one year, 15% (95% CI: 6–27%) at two years, and 19% (95% CI: 8–33%) at five years. The median overall duration of the fabrication process of the guide was 35 days (Q1–Q3: 26–47) from the first contact to the surgery date. Conclusions Patient-Specific Guides can provide a reproducible safe bony margin.

Keywords

• Primary malignant bone tumor
• Pelvis
• 3D printing
• Patient-specific instrument