Long-term outcomes of computer navigation-assisted resection for primary pelvic sarcomas

The aim of this study was to evaluate the long-term outcomes of computer navigation-assisted resection for primary pelvic bone tumours. Using our prospectively collected oncology database, a retrospective case control study was conducted on 63 patients who underwent computer navigation-assisted resection and 145 patients who underwent non-navigated resection for primary pelvic sarcomas between January 2000 and December 2018. The rates of local recurrence and mortality were calculated using the Kaplan-Meier method. The function and complications were recorded in the follow-up. The local recurrence rates were 9.5% (6/63) in the navigation group and 19.3% (31/145) in the non-navigation group, respectively (p = 0.040). The two-, five-, and ten-year local recurrence-free survival (LRFS) rates were significantly higher in the navigation compared with non-navigation group (two-year 95% (95% CI 85 to 98) vs 86% (95% CI 79 to 91); p = 0.041; five-year and ten-year 89% (95% CI 77 to 95) vs 75% (95% CI 66 to 82); p = 0.025). Meanwhile, the two-, five-, and ten-year disease-specific survival (DSS) rates were statistically higher in the navigation compared with the non-navigation group (two-year 89% (95% CI 78 to 95) vs 76% (95% CI 68 to 82); p = 0.032; five-year 85% (95% CI 74 to 92) vs 63% (95% CI 54 to 71); p < 0.001; ten-year 85% (95% CI 74 to 92) vs 59% (95% CI 50 to 67); p < 0.001). The multivariate Cox regression showed that the use of navigation was associated with better LRFS and DSS. The mean Musculoskeletal Tumor Society (MSTS) scores were not found to be superior in the navigation group (85% (SD 10) in the navigation group vs 84% (SD 13) in the non-navigation group; p = 0.742). This study shows that computer navigation-assisted surgery improves the ability to achieve negative bone margins for primary pelvic sarcomas and has better DSS at long-term follow-up. Obtaining adequate soft-tissue margins remains a challenge, and our results show navigation assistance did not result in significant soft-tissue margin improvement. No function improvement was found, and further research is warranted to focus on precise resection and the important preservation of normal structures.