Background
Head and neck cancer (HNC) ranks as the seventh most prevalent cancer globally, according to 2020 statistics [1]. It encompasses malignancies originating in the upper aerodigestive tract [2], including the oral cavity, larynx, and pharynx [3]. Among these anatomical sites, the lips and oral cavity account for approximately 40% of all HNC cases, followed by the pharynx (35%) and larynx (20%) [1].
Oral squamous cell carcinoma (OSCC) represents nearly 90% of oral cavity cancers, with surgery being the primary treatment modality [4]. However, surgical resection of OSCC can significantly affect the patient's quality of life, leading to functional impairments such as difficulties with speaking, swallowing, and chewing, as well as compromised facial aesthetics. To mitigate these effects, reconstructive surgery is often undertaken to restore both form and function. The choice of reconstruction technique depends on several factors, including the volume and characteristics of the required tissue, potential donor site morbidity, and the surgeon’s experience and preference. For large tumours invading the mandible, the fibula free flap is regarded as the gold standard for reconstruction [5], while the anterolateral thigh flap is typically employed in cases without bony involvement [6].
Aim
The ROADIME-RESECTA project is dedicated to advancing the surgical treatment of HNC, particularly OSCC, by improving both radical tumour resection and the subsequent functional and aesthetic reconstruction using free flap techniques.
This goal is pursued through the integration of multi-modal imaging such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Positron Emission Tomography (PET), and Ultrasound (US), with 3D modelling, surgical navigation, and robotic technologies. By combining these resources, the project seeks to enhance the preoperative understanding of tumour location and infiltration, facilitate surgical decision-making and planning, and support accurate intraoperative tumour removal and reconstruction.
Developed through a collaborative effort between clinicians and technical physicians at the Netherlands Cancer Institute (NKI) and robotics experts at the Robotics and Mechatronics (RAM) group at the University of Twente, the project pursues two primary research directions:
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The development and application of 3D anatomical models and surgical navigation systems to support precise tumour resection in patients with oral cavity cancer.
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The optimisation and integration of imaging techniques to enable detailed preoperative planning for soft tissue reconstruction using free flap transfers.
Approaches
To meet these objectives, ROADIME-RESECTA has already implemented several innovative strategies:
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Enhancement of image-to-patient registration for both the mandible and fibula, facilitating the use of electromagnetic surgical navigation during mandibular resections reconstructed with fibula free flaps.
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Design and development of reusable navigated cutting guides for both the mandible and fibula, enabling precise tumour excision and defect reconstruction.
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Fusion of MRI, CT, and ultrasound modalities to enable preoperative perforator vessel mapping and 3D modelling for anterolateral thigh and fibula flap procedures.
Key Research Direction
Altogether, ROADIME-RESECTA aims to significantly improve surgical accuracy and patient outcomes in head and neck cancer care. By advancing preoperative planning tools and intraoperative navigation systems, the project targets enhanced oncological safety and superior functional rehabilitation, particularly for patients affected by OSCC.
References
[1] Sung, et al. "Global Cancer Statistics 2020: GLOBOCAN" Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries (2021).
[2] Retting, et al. "Epidemiology of Head and Neck Cancer" (2015).
[3] Gormley, et al. "Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors" (2022).
[4] Chinn, et al. "Oral Cavity Carcinoma: Current Management, Controversies, and Future Directions" (2015).
[5] Hidalgo "Fibula free flap: a new method of mandible reconstruction" (1989)
[6] Urken, et al. "Atlas of regional and free flaps for head and neck reconstruction: flap harvest and inserting" (2012).