Background:Three-dimensional virtual surgical planning (Three-dimensional VSP) has become standard practice in the treatment of mandibular oral squamous cell carcinoma (OSCC) in the last decade. Dutch guidelines recommend a care pathway interval (CPI) of a maximum of 30 days, and a free bone margin of at least 5 mm. Fused MRI and CT data are used for accurate tumor delineation. Based on this data, a virtual surgical plan is created and transferred to the operating room using resection guides and patient-specific implants (PSIs). Long-term evaluation is needed to further optimize its clinical use.Objectives:This study evaluates adherence to bone margin and CPI guidelines in mandibular OSCC. Additionally, it assesses the accuracy of tumor resection and reconstruction using 3D-VSP and compares the complications of 3D-planned mandibular reconstruction using different kinds of osteosynthesis plates.Methods:All patients who underwent a segmental mandibulectomy between 2014 and 2024 at the University Medical Center Groningen were included. CPI, clinical outcomes, and complications were analyzed. The preoperative virtual plan was compared with the postoperative outcome to assess accuracy.Results:The median CPI was 34 days, and 93.7% of bone margins were tumor-free. Mean absolute resection deviation was 1.63 mm (±1.42). PSI reconstructions were significantly more accurate in intergonial distance and coronal angle compared to conventional plates. Plate-related complications were more common in non-bony reconstructions; PSI reconstructions showed significantly more plate exposure.Conclusions:3D-VSP leads to high accuracy in resection and reconstruction and favorable bone margins. Shortening the CPI and reducing biological complications are essential to further improve oncological outcomes.
背景：在过去十年中，三维虚拟手术规划（三维VSP）已成为治疗下颌骨口腔鳞状细胞癌（OSCC）的标准实践。荷兰指南建议诊疗路径间隔（CPI）最多为30天，且骨切缘至少为5毫米。融合MRI和CT数据用于准确描绘肿瘤边界。基于这些数据，创建虚拟手术计划，并通过切除导板和患者特异性植入物（PSIs）转移到手术室。需要长期评估以进一步优化其临床应用。
目的：本研究评估下颌骨OSCC治疗中对骨切缘和CPI指南的依从性。此外，评估使用3D-VSP进行肿瘤切除和重建的准确性，并比较使用不同类型骨合成板的3D规划下颌骨重建的并发症。
方法：纳入2014年至2024年在格罗宁根大学医学中心接受节段性下颌骨切除术的所有患者。分析CPI、临床结果和并发症。将术前虚拟计划与术后结果进行比较以评估准确性。
结果：中位CPI为34天，93.7%的骨切缘无肿瘤。平均绝对切除偏差为1.63毫米（±1.42）。与传统接骨板相比，PSI重建在下颌角间距离和冠状角方面显著更准确。与非骨性重建相比，板相关并发症更常见；PSI重建显示板暴露显著更多。
结论：3D-VSP在切除和重建中实现高准确性，并获得良好的骨切缘。缩短CPI并减少生物并发症对于进一步改善肿瘤学结果至关重要。
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