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

Marco Ferrari; Piergiorgio Gaudioso; Stefano Taboni; Giacomo Contro; Giuseppe Roccuzzo; Paola Costantino; Michael J Daly; Harley H L Chan; Maxime Fieux; Alessandra Ruaro; Roberto Maroldi; Alberto Signoroni; Alberto Deganello; Jonathan C Irish; Florent Carsuzaa; Piero Nicolai

doi:10.1016/j.ejso.2024.109514

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

Eur J Surg Oncol. 2024 Dec 4;51(2):109514. doi: 10.1016/j.ejso.2024.109514. Online ahead of print.

Authors

Marco Ferrari¹, Piergiorgio Gaudioso², Stefano Taboni³, Giacomo Contro⁴, Giuseppe Roccuzzo⁵, Paola Costantino⁵, Michael J Daly⁶, Harley H L Chan⁶, Maxime Fieux⁷, Alessandra Ruaro⁸, Roberto Maroldi⁹, Alberto Signoroni¹⁰, Alberto Deganello¹¹, Jonathan C Irish¹², Florent Carsuzaa¹³, Piero Nicolai¹⁴

Affiliations

¹ 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.
² 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.
³ 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.
⁴ 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.
⁵ Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neuroscience, University of Padua, Padua, Italy.
⁶ Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
⁷ 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.
⁸ 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.
⁹ Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy.
¹⁰ Department of Information Engineering, University of Brescia, Brescia, Italy.
¹¹ Department of Otolaryngology-Head and Neck Surgery, IRCCS Istituto Nazionale Dei Tumori (INT), Milan, Italy.
¹² Department of Otolaryngology and Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
¹³ Department of Head and Neck Surgery, Poitiers University Hospital, Poitiers, France.
¹⁴ 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.

PMID: 39662109
DOI: 10.1016/j.ejso.2024.109514

Abstract

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.

Keywords: Computer-assisted; Head and neck cancer; Margin; Navigation; Precision medicine; Skull base; Surgery.

Publication types

Review