The role of Computer-Assisted Navigation in pelvic tumor surgery: a Systematic Review and Meta-Analysis

Pelvic bone tumors frequently pose significant challenges due to their proximity to noble structures, including blood vessels, nerves, and organs. Computer-assisted navigation (CAN) for pelvic bone oncology surgery was introduced in the early 2000s to improve accuracy and precision of pelvic tumor resections. The objective of this systematic review and meta-analysis was to evaluate the differences in surgical accuracy, clinical outcomes, recurrence rates, and complications in pelvic bone tumor resections performed with or without CAN. The literature search was independently conducted by two reviewers on September 30, 2024 on PubMed, Scopus, and Cochrane Library databases. Observational studies investigating oncologic outcomes associated with the use of navigation systems in the treatment of primary pelvic bone tumors were included. Meta-analysis was performed using Review Manager software to compare margin status, local recurrence (LR) rates, metastasis rates, and major complications between navigated and non-navigated pelvic tumor surgeries. Eleven studies comprising 402 patients (mean age 49.3 years) were included. CAN significantly reduced LR rate (p = 0.008) and increased the rate of negative margins (p = 0.0007) compared to non-navigated group. No significant differences were observed in metastasis rate (p = 0.18) or major complications (p = 0.16) between the two groups. The five-year overall survival averaged 78.5 % in navigated surgeries. CAN offers significant benefits in the treatment of pelvic tumors as enhances surgical precision, reduces LR, and increases wide-margin resections compared to non-navigated surgery.