Personalized Surgical Planning for Soft Tissue Sarcoma of the Popliteal Fossa with a Novel 3D Imaging Technique

Abstract

Objective: Soft tissue sarcomas (STSs) arising from the popliteal fossa pose surgical challenges due to their proximity to critical neurovascular structures. This study aimed to investigate whether a novel 3D imaging technique highlighting these key anatomical structures could facilitate preoperative planning and improve surgical outcomes in STS.

Methods: This was a prospective, observational, pilot study. Between November 2019 and December 2020, 27 patients with STS of the popliteal fossa undergoing limb-sparing procedures were enrolled and assigned to either a control or intervention group. Control patients underwent traditional preoperative planning with separate computed tomography angiography, magnetic resonance imaging, and magnetic resonance hydrography. In the intervention group, 3D images were generated from these images, the tumor and skeletomuscular and neurovascular structures were revealed in three dimensions, and this was visualized on the surgeon's smartphone or computer. Primary endpoints were surgical margins and complications. Secondary endpoints included operative time, blood loss, serum C-reactive protein and interleukin-6, length of in-hospital stay, and limb function. Comparisons between groups were made using independent-sample t-tests for continuous data and the Mann-Whitney U and Fisher's exact tests for categorical data.

Results: There was a lower but not significantly different inadvertent positive margin rate (1/15 vs. 3/12, P = 0.294), significantly shorter hospital stay (P = 0.049), and less numbers ≥75th percentile of operative time (P = 0.037) and blood loss (P = 0.024) in the intervention group. Differences in surgical complications, operative time, blood loss, C-reactive protein and interleukin-6 levels on the second postoperative day, and limb functional scores were statistically insignificant.

Conclusions: The novel 3D imaging technique facilitates complex preoperative planning and limb-salvage surgical procedures for patients with STS of the popliteal fossa, and this may affect how surgical planning is performed in the future.

Keywords: 3D imaging; Length of hospital stay; Neurovascular evaluation; Personalized surgery; Popliteal fossa.

Fig. 1

Flow chart of participant inclusion in this study

Fig. 2

Classic images and three‐dimensional reconstruction in a patient with popliteal fossa synovial sarcoma. CT angiography image (A), T1‐weighted MRI (B), MR hydrography image (C), 3D reconstruction image (D) in similar axial views. Posterior and lateral view of the 3D reconstruction image (E, F). Abbreviations: PA, popliteal artery; CFN, common fibular nerve; TN, tibial nerve; Tu, tumor