# A Dangerous Region Generation Method for Computer-Assisted Pelvic Bone Tumor Resection Surgery: A Retrospective Study

## TL;DR

This study introduces a new method for improving surgical accuracy in pelvic tumor removal, showing good clinical results in patients.

## Contribution

A novel dangerous region generation method using 3D image resampling and anisotropic distance transform for pelvic tumor resection.

## Key findings

- All patients achieved adequate surgical margins with the new method.
- The 5-year overall survival rate was 75.6%, with 80.0% for wide-margin resections.
- Patients showed high functional recovery, with an average MSTS score of 26.6.

## Abstract

Background: Achieving adequate margins in pelvic bone tumor resection remains difficult, as conventional navigation provides no direct three-dimensional margin feedback. We proposed an innovative dangerous region generation method based on 3D image resampling and anisotropic distance transform, integrated with computer-assisted navigation, to enhance surgical margin accuracy. This study aimed to evaluate its oncological safety, functional outcomes, and perioperative efficacy in pelvic tumor surgery. Methods: The study was conducted on 19 patients (8 males, 11 females) with primary pelvic bone tumors between May 2018 and June 2024. The age range was 19 to 66 years (mean age: 62.67 years). Histological diagnoses included chondrosarcoma (n = 6), giant cell tumor (n = 4), osteosarcoma (n = 1), chordoma (n = 2), Ewing sarcoma (n = 3), spindle cell sarcoma (n = 1), chondromyxoid fibroma (n = 1), and peripheral nerve sheath tumor (n = 1). The feasibility of the dangerous region generation method for computer-assisted pelvic tumor resection surgery was assessed by general results, oncological and functional results. Results: All patients successfully underwent surgery with a mean operative time of 252 min and average intraoperative blood loss of 1358 mL. The mean hospital stay was 22 days, and all patients completed follow-up (mean, 37 months). Two patients developed postoperative wound complications, which resolved after debridement. Adequate surgical margins were achieved in all cases. The 5-year overall survival rate was 75.6%, increasing to 80.0% among patients with wide-margin resections. At the final follow-up, the mean MSTS score among 16 limb-salvage patients was 26.6, corresponding to an average functional recovery of 88.5%. Most patients exhibited a normal gait and were able to ambulate without assistive devices. Conclusions: This dangerous region generation method, when combined with computer-assisted techniques for pelvic bone tumor resection, is feasible and can achieve favorable clinical outcomes.