Curettage of grade one chondrosarcoma in the long bones; a retrospective analysis of treatment assisted with fluoroscopy versus computer assisted surgery.

Gerbers, J. (Jasper) (2014) Curettage of grade one chondrosarcoma in the long bones; a retrospective analysis of treatment assisted with fluoroscopy versus computer assisted surgery. thesis, Medicine.

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Abstract

Introduction: Curettage is a surgical technique used for the treatment of intramedullary bone tumours. It requires intra-operative imaging, currently two-dimensional fluoroscopy. Computer Assisted Surgery (CAS) offers continuous, high resolution 3D feedback, this while not using ionizing radiation. This study compares clinical results of the treatment supported with fluoroscopy versus CAS. Patients and Methods: A retrospective cohort study was performed. Recurrence, residue and complication rates were measured. Further measurements for treatment margin were performed for the CAS cohort on margin achieved during the procedure. Results: 79 patients were included, 60 patients in the fluoroscopy cohort, 19 in the CAS cohort. Follow-up was on average 33.1 and 25.0 months. Patient characteristics differed only significantly on lesion width. There were no recurrences. There were four suspected residues on MRI in the fluoroscopy cohort and two confirmed residues in the CAS cohort. There was no significant difference in fracture rate (10% vs 15.8%, p=0.44). PMMA cement did not prove a risk factor for fractures. Measured margins were on average 5.7 mm. Discussion: Due to another running study, the average calculated tumor size was larger than in comparable studies. MRI baseline follow-up shows that many studies possibly over report on local recurrences and under report on treatment failures (i.e. non complete curettages). Conclusion: Both cohorts show excellent results, comparable or better than the literature, even with a possible negative tumour size bias. Workflow using the CAS machine after the learning curve has been of additional value and time-efficient. Fracture rates in both groups were higher than expected. More research is needed to develop a curettage specific workflow and to analyse the long term effects of CAS.

Item Type:	Thesis (Thesis)
Supervisor name:	Jutte and Stevens, Dr. M.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2637

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