Digital 3D Technology in Pediatric Surgical Oncology: An Expert White Paper.

Digital three-dimensional (3D) visualization is an evolving field that is being introduced into pediatric surgical oncology, where it addresses challenges related to complex anatomy and difficulties accurately defining surgical margins. This paper provides an overview of digital 3D modeling in pediatric surgical oncology and explores ways to further advance this field. Digital 3D models may improve various aspects of surgery, such as preoperative planning, intraoperative guidance, patient education, and surgical training. Traditionally, 3D models are manually or semi-automatically segmented. More recently, artificial intelligence (AI) can automatically segment pediatric solid tumors. For preoperative planning, 3D models improve anatomic understanding and help multidisciplinary communication. During surgery, these models can assist the surgeon in accurately localizing tumors and determining resection margins in preclinical research settings. In patient education, 3D models present an opportunity to improve patient understanding of disease, therapy, and surgical risks. Lastly, digital 3D models are used in surgical training, particularly for challenging cases. Although digital 3D technologies are evaluated using technical performance metrics, these measures do not necessarily result in improved clinical outcomes. Consequently, evidence demonstrating improved surgical outcomes remains limited, also due to the small patient cohorts. Several challenges continue to hinder clinical translation, including image quality and standardization, segmentation complexity, organ deformability during surgery, and insufficient clinical validation. Addressing these limitations will require progress in four key areas: AI integration, multicenter validation, the development of centralized infrastructures including digital twins, and scalable implementation strategies that support widespread clinical adoption.