This retrospective historically controlled study from Leiden asks whether intraoperative navigation improves surgical margin quality in pelvic and sacral primary bone sarcoma resections. 36 navigated cases (CT fluoroscopy or intraoperative CT, 2008–2017) were compared with 34 nonnavigated cases performed before navigation was available at the institution (2000–2008). The primary outcome was bone and soft-tissue margin adequacy, classified by a modified Enneking system.
Pelvic and sacral sarcoma resections carry local recurrence rates of 20–40% overall, rising to 70% with positive margins — yet achieving negative margins here is far harder than in the extremities. The study makes a clear practical distinction: navigation solves the bone cut problem, not the soft-tissue problem.
When you plan a pelvic or sacral sarcoma resection, use navigation to execute your osteotomies. It improves adequate bone margin rates from 50% to 81% without adding operative time, blood loss, or complication risk. Do not expect navigation to rescue your soft-tissue margins: if the tumor abuts the sciatic nerve or iliac vessels, that is a biology and anatomy problem, not a technology problem.
Chondrosarcoma and chordoma dominate this patient population and are poorly responsive to neoadjuvant chemotherapy and radiation. Which means the surgical margin is effectively the only oncologic lever you have, making the margin improvement shown here directly relevant to disease-specific survival.
This retrospective historically controlled study from Leiden asks whether intraoperative navigation improves surgical margin quality in pelvic and sacral primary bone sarcoma resections. 36 navigated cases (CT fluoroscopy or intraoperative CT, 2008–2017) were compared with 34 nonnavigated cases performed before navigation was available at the institution (2000–2008). The primary outcome was bone and soft-tissue margin adequacy, classified by a modified Enneking system.
Pelvic and sacral sarcoma resections carry local recurrence rates of 20–40% overall, rising to 70% with positive margins — yet achieving negative margins here is far harder than in the extremities. The study makes a clear practical distinction: navigation solves the bone cut problem, not the soft-tissue problem.
When you plan a pelvic or sacral sarcoma resection, use navigation to execute your osteotomies. It improves adequate bone margin rates from 50% to 81% without adding operative time, blood loss, or complication risk. Do not expect navigation to rescue your soft-tissue margins: if the tumor abuts the sciatic nerve or iliac vessels, that is a biology and anatomy problem, not a technology problem.
Chondrosarcoma and chordoma dominate this patient population and are poorly responsive to neoadjuvant chemotherapy and radiation. Which means the surgical margin is effectively the only oncologic lever you have, making the margin improvement shown here directly relevant to disease-specific survival.