Intraoperative surgical navigation improves margin status in advanced malignancies of the anterior craniofacial area: A prospective observational study with systematic review of the literature and meta-analysis.

Autor: Ferrari M; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale Università Padova, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Canada. Electronic address: marco.ferrari@unipd.it., Gaudioso P; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale Università Padova, Padua, Italy; Oncology and Immunology (PhD Program), Department of Surgery Oncology and Gastroenterology (DiSCOG), University of Padova, Padova, Italy., Taboni S; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale Università Padova, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Canada., Contro G; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale Università Padova, Padua, Italy; Technology for Health (PhD program), Department of Information Engineering, University of Brescia, Brescia, Italy., Roccuzzo G; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy., Costantino P; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy., Daly MJ; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada., Chan HHL; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada., Fieux M; Hospices Civils de Lyon, Hôpital Lyon Sud, Service D'ORL, D'otoneurochirurgie et de Chirurgie Cervico-faciale, F-69310, Pierre Bénite, Université de Lyon, Université Lyon 1, F-69003, Lyon, France., Ruaro A; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, Canada; Department of Otolaryngology and Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada., Maroldi R; Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, 'ASST Spedali Civili di Brescia', University of Brescia, Brescia, Italy., Signoroni A; Department of Information Engineering, University of Brescia, Brescia, Italy., Deganello A; Department of Otolaryngology-Head and Neck Surgery, IRCCS Istituto Nazionale Dei Tumori (INT), Milan, Italy., Irish JC; Department of Otolaryngology and Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada., Carsuzaa F; Department of Head and Neck Surgery, Poitiers University Hospital, Poitiers, France., Nicolai P; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Azienda Ospedale Università Padova, Padua, Italy.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Dec 04; Vol. 51 (2), pp. 109514. Date of Electronic Publication: 2024 Dec 04.
DOI: 10.1016/j.ejso.2024.109514
Abstrakt: The current scientific evidence suggests that surgical navigation (SN) can contribute to improve oncologic outcomes in sinonasal and craniofacial surgery. The present study investigated the feasibility of intraoperative SN and its role in improving the outcomes of surgically treated sinonasal and craniofacial tumors. This prospective study compared navigation-guided surgery for sinonasal or craniofacial malignancies with a pair-matched cohort (1:2 matching) of patients operated without SN. A systematic review of the literature was performed. Thirty-five patients who underwent navigation-guided surgery were included. The pair-matched control cohort included 70 patients operated without SN. The margin status analysis demonstrated a lower rate of positive margins (p = 0.013) in the SN group, especially in pT4 (p = 0.034), recurrent (p = 0.024), high-grade tumors (p = 0.043), and endoscopic-assisted open surgery (p = 0.035). The mean preoperative time did not show a significant difference between surgeries performed with or without SN (1.26 vs. 1.23 h, p = 0.445). However, surgeries utilizing SN had a significantly longer median duration compared to those without (8.10 vs. 6.00 h, p = 0.029). A total of 209 patients were included in the meta-analysis; 91 patients (43.5 %) underwent surgery with SN. The results of the meta-analysis showed an improvement in terms of negative margins rate with the use of SN (OR = 2.62; 95%-confidence interval: 1.33-5.17). In conclusion, intraoperative SN can contribute to achieve a clear margin resection, especially in locally advanced tumors, recurrences, highly aggressive histologies, and when endoscopic-assisted open surgery is employed.
Competing Interests: Declaration of conflicting interests As of April 2024, Dr. Marco Ferrari and Prof. Piero Nicolai are members of an advisory board on the use of steroid-eluting resorbable stents (Propel®) distributed by the same vendor of the navigation system used in the present study (Medtronic®). Other author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: