IADR Abstract Archives
“Out of House” Virtual Surgical Planning for Mandible Reconstruction After Cancer Resection: is it Oncologically Safe?
Objectives: Virtual surgical planning for mandible reconstruction reduces operative and flap ischaemic times while allowing accurate contouring of the neomandible with precise osteotomies. Without “in-house” planning and printing facilities, there is a turnaround time of up to 3 weeks between the online planning session and taking delivery of the custom cutting guides and fixation implant. In some cases this may delay surgery and there may be concern about planning cancer resection margins so far in advance of surgery.
The purpose of this study was to investigate whether the time delay between “out of house” proprietary virtual surgical planning of the mandibular resection for oral cancer and the day of surgery results in compromised margins and oncological disadvantage for the patient.
Methods: A single-centre, single-operator case control study comparing vritually planned surgery and conventional mandibular reconstruction after cancer resection was performed. Patients undergoing bony reconstruction of their mandible after cancer resection between September 2015 and March 2020 were identified from a prospectively maintained free flap database. Time to surgery, margin status and reconstructive outcomes were compared.
Results: The groups were matched in patient demographics, tumour stage and size, nodal status and reconstruction complexity.
53 patients had osseous free flap reconstruction of their mandible after cancer resection during the study period. There were 25 patients in the VSP group and 28 in the non-VSP group. The median age was 62 (11-84) years and 38 (72%) were male. There were 42 (79%) fibulas and 11 (21%) scapulas.
VSP resulted in a significant reduction in operating time (p<0.01). VSP did not affect bony (p=0.49) or soft tissue (p=0.22) margin status.
Conclusions: This study shows that despite the time delay between planning the surgical margins during VSP and performing the tumour resection, there is no increase in positive or close resection margins. The results also confirm that virtual surgical planning reduces operative time for mandibular reconstruction by almost one hour on average.
The purpose of this study was to investigate whether the time delay between “out of house” proprietary virtual surgical planning of the mandibular resection for oral cancer and the day of surgery results in compromised margins and oncological disadvantage for the patient.
Methods: A single-centre, single-operator case control study comparing vritually planned surgery and conventional mandibular reconstruction after cancer resection was performed. Patients undergoing bony reconstruction of their mandible after cancer resection between September 2015 and March 2020 were identified from a prospectively maintained free flap database. Time to surgery, margin status and reconstructive outcomes were compared.
Results: The groups were matched in patient demographics, tumour stage and size, nodal status and reconstruction complexity.
53 patients had osseous free flap reconstruction of their mandible after cancer resection during the study period. There were 25 patients in the VSP group and 28 in the non-VSP group. The median age was 62 (11-84) years and 38 (72%) were male. There were 42 (79%) fibulas and 11 (21%) scapulas.
VSP resulted in a significant reduction in operating time (p<0.01). VSP did not affect bony (p=0.49) or soft tissue (p=0.22) margin status.
Conclusions: This study shows that despite the time delay between planning the surgical margins during VSP and performing the tumour resection, there is no increase in positive or close resection margins. The results also confirm that virtual surgical planning reduces operative time for mandibular reconstruction by almost one hour on average.