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Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery
Curatively intended oncologic surgery is based on a residual-free tumor excision. Since decades, the surgeon’s goal of R0-resection has led to radical resections in the anatomical region of the midface because of the three-dimensionally complex anatomy where aesthetically and functionally crucial st...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560787/ https://www.ncbi.nlm.nih.gov/pubmed/34737947 http://dx.doi.org/10.3389/fonc.2021.719528 |
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author | Wilkat, Max Kübler, Norbert Rana, Majeed |
author_facet | Wilkat, Max Kübler, Norbert Rana, Majeed |
author_sort | Wilkat, Max |
collection | PubMed |
description | Curatively intended oncologic surgery is based on a residual-free tumor excision. Since decades, the surgeon’s goal of R0-resection has led to radical resections in the anatomical region of the midface because of the three-dimensionally complex anatomy where aesthetically and functionally crucial structures are in close relation. In some cases, this implied aggressive overtreatment with loss of the eye globe. In contrast, undertreatment followed by repeated re-resections can also not be an option. Therefore, the evaluation of the true three-dimensional tumor extent and the intraoperative availability of this information seem critical for a precise, yet substance-sparing tumor removal. Computer assisted surgery (CAS) can provide the framework in this context. The present study evaluated the beneficial use of CAS in the treatment of midfacial tumors with special regard to tumor resection and reconstruction. Therefore, 60 patients diagnosed with a malignancy of the upper jaw has been treated, 31 with the use of CAS and 29 conventionally. Comparison of the two groups showed a higher rate of residual-free resections in cases of CAS application. Furthermore, we demonstrate the use of navigated specimen taking called tumor mapping. This procedure enables the transparent, yet precise documentation of three-dimensional tumor borders which paves the way to a more feasible interdisciplinary exchange leading e.g. to a much more focused radiation therapy. Moreover, we evaluated the possibilities of primary midface reconstructions seizing CAS, especially in cases of infiltrated orbital floors. These cases needed reduction of intra-orbital volume due to the tissue loss after resection which could be precisely achieved by CAS. These benefits of CAS in midface reconstruction found expression in positive changes in quality of life. The present work was able to demonstrate that the area of oncological surgery of the midface is a prime example of interface optimization based on the sensible use of computer assistance. The fact that the system makes the patient transparent for the surgeon and the procedure controllable facilitates a more precise and safer treatment oriented to a better outcome. |
format | Online Article Text |
id | pubmed-8560787 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85607872021-11-03 Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery Wilkat, Max Kübler, Norbert Rana, Majeed Front Oncol Oncology Curatively intended oncologic surgery is based on a residual-free tumor excision. Since decades, the surgeon’s goal of R0-resection has led to radical resections in the anatomical region of the midface because of the three-dimensionally complex anatomy where aesthetically and functionally crucial structures are in close relation. In some cases, this implied aggressive overtreatment with loss of the eye globe. In contrast, undertreatment followed by repeated re-resections can also not be an option. Therefore, the evaluation of the true three-dimensional tumor extent and the intraoperative availability of this information seem critical for a precise, yet substance-sparing tumor removal. Computer assisted surgery (CAS) can provide the framework in this context. The present study evaluated the beneficial use of CAS in the treatment of midfacial tumors with special regard to tumor resection and reconstruction. Therefore, 60 patients diagnosed with a malignancy of the upper jaw has been treated, 31 with the use of CAS and 29 conventionally. Comparison of the two groups showed a higher rate of residual-free resections in cases of CAS application. Furthermore, we demonstrate the use of navigated specimen taking called tumor mapping. This procedure enables the transparent, yet precise documentation of three-dimensional tumor borders which paves the way to a more feasible interdisciplinary exchange leading e.g. to a much more focused radiation therapy. Moreover, we evaluated the possibilities of primary midface reconstructions seizing CAS, especially in cases of infiltrated orbital floors. These cases needed reduction of intra-orbital volume due to the tissue loss after resection which could be precisely achieved by CAS. These benefits of CAS in midface reconstruction found expression in positive changes in quality of life. The present work was able to demonstrate that the area of oncological surgery of the midface is a prime example of interface optimization based on the sensible use of computer assistance. The fact that the system makes the patient transparent for the surgeon and the procedure controllable facilitates a more precise and safer treatment oriented to a better outcome. Frontiers Media S.A. 2021-10-19 /pmc/articles/PMC8560787/ /pubmed/34737947 http://dx.doi.org/10.3389/fonc.2021.719528 Text en Copyright © 2021 Wilkat, Kübler and Rana https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Wilkat, Max Kübler, Norbert Rana, Majeed Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title | Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title_full | Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title_fullStr | Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title_full_unstemmed | Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title_short | Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery |
title_sort | advances in the resection and reconstruction of midfacial tumors through computer assisted surgery |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560787/ https://www.ncbi.nlm.nih.gov/pubmed/34737947 http://dx.doi.org/10.3389/fonc.2021.719528 |
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