Combined interdisciplinary treatment of metastatic bone lesions using 3D robot-assisted image-guided navigation : Embolization, biopsy, ablation, and surgery in one operative session.

Abstract

Objective: To maximize local tumor control, stabilize affected bones, and preserve or replace joints with minimal interventional burden, thereby enhancing quality of life for empowered living.

Indications: Suitable for patients with bone metastases, particularly those with severe pain and/or fractures and appropriate life expectancy.

Contraindications: In primary bone tumors, refer to the sarcoma surgery team for evaluation of wide resection. For patients with poor general condition and/or limited life expectancy (< 6 weeks), consider best supportive care.

Surgical technique: Radiological interventions involve angiography and embolization for hypervascularized metastases, followed by precise biopsy and local tumor control through radiofrequency ablation or cryoablation using navigated imaging. The surgical treatment aims to create a durable, minimally invasive construct for stability, considering various options from percutaneous screws with cement augmentation to joint replacement. Intraoperative imaging and 3D scans guide the procedure, ensuring accurate placement of implants and confirming optimal results.

Postoperative management: Postoperative care involves immediate mobilization with pain-adapted full weightbearing and daily physiotherapy. The goal is to regain preoperative mobility. Follow-up with regular clinical and radiographic assessments and CT in the case of tumor progression and complications.

Results: Since introducing the combined surgical and interventional therapy in October 2021, 16 patients have undergone successful procedures. Complications included material failure, component loosening, and surgical site infection. Five patients (31%) died during observation, while surviving patients surpassed their estimated survival, emphasizing the advantages of minimally invasive treatment with durable constructs.