Comparative Study Of Couinaud Liver Segmentation And Blood Flow Topology Liver Segmentation Based On 3D Visualization Technology In The Diagnosis And Treatment Of Primary Liver Cancer

BackgroundHepatectomy is the best treatment option for primary liver cancer(PLC).Given the complex anatomy of the liver,there is still a high incidence of postoperative complications despite advanced techniques in bleeding control,hepatic parenchyma amputation and hemostasis,especially in the operation of complex hepatic cancer(CHC).Couinaud liver segmentation method is based on the liver anatomical markers for manual segmentation,while the blood flow topology liver segmentation method is based on the blood flow topology of the portal vein in the liver.Both of them are widely used in the clinic,but there is no comparative study on the liver segmentation of Couinaud and blood flow topology liver segmentation in PLC surgery.Three-dimensional visualization(3DV)technology has changed the traditional two-dimensional diagnosis and treatment modality,and it has been widely used in preoperative evaluation and surgical planning;however,the impact of 3DV technology on CHC radical resection rate and surgical decision-making has been rarely reported.Methods1.Construction of three-dimensional liver models has been performed separately for 131 cases of primary liver cancer to analyze the three-dimensional anatomy of intrahepatic vessels.Simulated liver resection and liver volume calculations were performed based on Couinaud liver segmentation method and blood flow topology liver segmentation method,respectively;the consistency and difference of the two were subsequently evaluated.The value of the latter was evaluated in the actual operation of primary liver cancer.2.71 patients with CHC who underwent surgery were evaluated by 2D and 3DV,respectively.The actual operation was set as the gold standard;the difference of 2D and 3DV evaluation in surgical planning was studied from the perspectives of tumor resectability and surgical decision-making.3.T-test,Mann-Whitney U test or Chi-square test were used according to the data type,and p<0.05 was considered statistically significant.Results1.The portal vein variation rate and hepatic artery variation rate of the 131 cases of primary liver cancer were 19.1%and 8.4%,respectively.The third-ordered branch of the right portal vein had 2 to 10 branches,which vary widely.In the right anterior lobe of the liver,35.9%had clear anatomical boundaries of segments 5 and 8,and in the right posterior lobe of the liver,50.4%had clear anatomical boundaries of segments 6 and 7.There were significant differences in left hepatic volume(417.60±196.11 vs.369.86±151.83ml)and right hepatic volume(749.95±254.98 vs.781.93±233.02ml)measured based on Couinaud liver segmentation and blood flow topology liver segmentation method(p<0.05),respectively.The volume of the right anterior lobe(325.23±120.13 vs.412.41±170.02ml)and the right posterior lobe(454.90±135.51 vs.371.09±150.44ml)measured respectively by the same method were significantly different(p<0.05).It was found that portal vein variation was an important factor affecting the results of individualized liver segmentation and liver volume calculation.In the actual operation,individualized liver segmentation,ICG fluorescence imaging and augmented reality technique were used.There were no perioperative deaths,and no liver failure occurred postoperatively.2.Among the 71 patients with CHC,63 of them were resectable,and 8 of them were unresectable by preoperative 2D evaluation,while all the 71 cases were resectable evaluated by 3DV.The actual operation was resectable in 69 cases and unresectable in 2 cases.The accuracy,false-positive rate and false-negative rate of 2D and 3DV in evaluating tumor resection were 85.9%,2.8%,11.3%and 97.2%,2.8%,0%,respectively.Compared with 2D,3DV had statistical significance in the accuracy rate(97.2%vs.85.9%,p=0.008).In 23 patients,the surgical decision of 2D evaluation was changed by 3DV evaluation(32.4%,23/71).Conclusions1.Compared with the Couinaud liver segmentation method,the liver segmentation method based on blood flow topology can show the three-dimensional anatomy and vascular variation of the liver more accurately;according to this method,simulated hepatectomy and hepatic volume calculation can be performed,thus better guiding precision hepatectomy.2.Compared with 2D,3DV has more advantages in CHC resectability evaluation and surgical decision-making,which can improve the radical resection rate of CHC,optimize surgical decision-making and improve surgical safety.