Antecedentes y objetivo: La utilización de guías impresas en 3D ha demostrado mejorar la precisión en osteotomías pélvicas en cadáver y obtener mejores márgenes quirúrgicos in vivo. Este estudio analiza su impacto sobre la supervivencia global y libre de enfermedad a medio-largo plazo en pacientes con tumores del anillo pélvico.
Materiales y métodos: Se diseñó un estudio de cohortes con 25 pacientes con sarcomas pélvicos o sacros primarios, 10 en el grupo 3D y 15 en el grupo control, con un seguimiento medio de 47 meses. Se compararon los márgenes obtenidos (libres, marginales o intralesionales) y se analizaron las curvas de supervivencia libre de enfermedad y global.
Resultados: La tasa de márgenes libres fue mayor en el grupo 3D (80% vs 66.7%, p=0.345). Las tasas de recidiva local (50% vs 60%, p=0.244) y a distancia (20% vs 47%, p=0.132) fueron menores en el grupo 3D. La supervivencia global fue mayor en el grupo 3D (60% vs 40%, p=0.327). La tasa de complicaciones fue similar en ambos grupos (40% de infección profunda).
Conclusiones: El uso de guías 3D en la resección de tumores pélvicos primarios no solo consigue una tasa de márgenes libres superior y un mejor control local de la enfermedad, sino que también muestra una tendencia hacia una mayor supervivencia libre de enfermedad a distancia (87% vs 53%, p=0.293) y global (60% vs 40%, p=0.327) a medio plazo.
Background and objectives: 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients.
Material and methods: A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed.
Results: The 3D group achieved a higher rate of free margins (80% vs 66.7%, p=0.345). Local recurrence (50% vs 60%, p=0.244) and distant disease relapse (20% vs 47%, p=0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p=0.327). The complication rate was similar in both groups, with a deep infection rate of 40%.
Conclusions: The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.
