Hiroshi Kobayashi1, Toru Akiyama1,2, Tomotake Okuma1, Yusuke Shinoda1, Hiroyuki Oka3, Nobuaki Ito4, Seiji Fukumoto4, Sakae Tanaka1, Hirotaka Kawano1,5. 1. a Department of Orthopaedic Surgery, Faculty of Medicine , The University of Tokyo , Tokyo , Japan. 2. b Department of Orthopaedic Surgery , Saitama Medical Center, Jichi Medical University , Saitama , Japan. 3. c Department of Medical Research and Management for Musculoskeletal Pain , 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo , Tokyo , Japan. 4. d Department of Nephrology and Endocrinology, Faculty of Medicine , University of Tokyo , Tokyo , Japan. 5. e Department of Orthopaedic Surgery, Faculty of Medicine , University of Teikyo , Tokyo , Japan.
Abstract
PURPOSE: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors. Segmental resection has been recommended for these tumors in the bones because curettage was found to be associated with a high local recurrence rate. Navigation-assisted surgery provides radiological information to guide the surgeon during surgery. No previous study has reported on the efficacy of navigation-assisted surgery for tumors in patients with TIO. Therefore, the present study aimed to evaluate the efficacy of navigation-assisted surgery for tumors in patients with TIO. METHODS: The study included seven patients with TIO who were treated between January 2003 and December 2014 at our hospital. All patients underwent surgical treatment with or without the use of a 3-dimensional (3D) fluoroscopy-based navigation system. The laboratory data and oncological outcomes were evaluated. RESULTS: The follow-up period was 8-128 months. The tumors were located at the femur (n = 4), ischium, spine and ilium (n = 1). Of the seven patients, five underwent navigation-assisted surgery and two underwent surgery without navigation assistance. In the two patients who underwent surgery without navigation assistance, a complete cure was not obtained and osteomalacia did not resolve. One of these two patients and the other five patients who underwent navigation-assisted surgery, one patient had incomplete resection due to massive invasion of the tumor into the spinal canal, but five patients achieved complete excision and recovered from osteomalacia. CONCLUSIONS: Navigation-assisted surgery using a 3D fluoroscopy-based navigation system is effective for tumors in patients with TIO.
PURPOSE:Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors. Segmental resection has been recommended for these tumors in the bones because curettage was found to be associated with a high local recurrence rate. Navigation-assisted surgery provides radiological information to guide the surgeon during surgery. No previous study has reported on the efficacy of navigation-assisted surgery for tumors in patients with TIO. Therefore, the present study aimed to evaluate the efficacy of navigation-assisted surgery for tumors in patients with TIO. METHODS: The study included seven patients with TIO who were treated between January 2003 and December 2014 at our hospital. All patients underwent surgical treatment with or without the use of a 3-dimensional (3D) fluoroscopy-based navigation system. The laboratory data and oncological outcomes were evaluated. RESULTS: The follow-up period was 8-128 months. The tumors were located at the femur (n = 4), ischium, spine and ilium (n = 1). Of the seven patients, five underwent navigation-assisted surgery and two underwent surgery without navigation assistance. In the two patients who underwent surgery without navigation assistance, a complete cure was not obtained and osteomalacia did not resolve. One of these two patients and the other five patients who underwent navigation-assisted surgery, one patient had incomplete resection due to massive invasion of the tumor into the spinal canal, but five patients achieved complete excision and recovered from osteomalacia. CONCLUSIONS: Navigation-assisted surgery using a 3D fluoroscopy-based navigation system is effective for tumors in patients with TIO.