Application Of Three Dimensional Reconstruction For Major Hepatectomy In Preoperative Planning Of Hepatic Malignancy

Objective The aim of the study was to evaluate the value of 3D visualization technology in the preoperative planning of hepatic malignancy surgery and the safety of extensive hepatectomy and extended hepatectomy.Methods The clinical data of 42 patients with hepatic malignancy was retrospectively collected who underwent radical resection surgery after 3D reconstruction assessment from February 2015 to February 2018 in our center.Preoperative evaluation was done based on the computed tolnography data,and the volume of resected liver were calculated using simulation.The predicted resected liver volume were compared with the results of the actual operations.Results(1)Three-dimensional reconstruction and simulated surgery: The evaluated tumor volume,total liver volume,standard liver volume,expected residual liver volume,residual liver volume ratio,residual liver volume/total liver volume of 42 patients' preoperative three-dimensional reconstruction were(780.2±597.6)ml,(1170.1±311.1)ml,(1241.8±101.8)ml,(695.6±250.1)ml,57.6%±18.8%,60.9%±20.5% respectively.(2)Surgical results: All the 42 patients underwent radical surgery,including 5 cases of left hemihepatectomy,20 cases of right hemihepatectomy,6 cases of mesohepatectomy,enlarged left hemihepatectomy in 5 patients,enlarged right hemihepatectomy in 4 patients,retained right hemihepatectomy in 2 patients and there were no operative deaths.The average operation time was(303±109)minutes,the average intraoperative blood loss was(510±482)ml,and 28 patients(66.7%)had intraoperative lines.Hepatic occlusion,in which the first hepatic hilum block in 25 cases(average cumulative block 30min),half hepatic block in 1 case(18min),hepatic inferior vena cava block in 1 case(50min),first hepatic hilar occlusion(cumulative 54min)1 case with hepatic blood flow blockade(22min).Postoperative Clavien III complications occurred in 5 cases,including 1 case of upper gastrointestinal bleeding,2 cases of severe pleural effusion,and 2 case of hepatic failure,which were all improved after being symptomatic treatment.32 cases of 42 patients with hepatocellular carcinoma,8 cases of cholangiocarcinoma,1 case of adenosquamous carcinoma,1 case of embryonal sarcoma were Pathologically confirmed.The average postoperative hospitalization was(12.2±6.1)days.No complications and deaths occurred in 1 month after surgery.(3)Comparison between the actual excisional liver volume and the predicted excisional liver volume: In terms of the resection liver volume,there was no significant difference between the predicted results and actual results[resection liver volume:(1143.4±584.2)ml vs(1091.2±570.4)ml,t=0.414,P>0.05].There was a strong positive correlation between AELV and PELV(AELV=0.97×PELV+21.19,r=0.996,P<0.01).PELV(ICC=0.998)was highly consistent with AELV data,and the difference was not significant(P<0.001).(4)Typical case: After 3D visual assessment,the patient actually retained part of the V VIII segment of the right hemihepatectomy,and recovered smoothly after surgery.The biochemical indicators were normal after one month of follow-up,and there was no tumor recurrence or complications.Conclusion 1.Preoperative three-dimensional visualization technique of hepatic malignant can accurately reflect the location of tumor and blood vessels,calculate the volume of whole liver and future liver remnant,which can be contributing to a accurate surgical planning.2.There was a strong positive correlation between the actual excisional liver volume and the predicted excisional liver volume,suggesting that three-dimensional visualization of preoperative surgical planning have a great significance to the major hepatectomy even extended hepatectomy.3.For patients with liver cirrhosis,semi-hepatectomy or extended hepatectomy can be considered as follows:(1)solitary large liver cancer without extrahepatic metastasis;(2)Liver function Child A,ICG R15 < 10%,STLVR?40% by three-dimensional imaging evaluation(Some patients can also choose surgical treatment when STLVR is in the range of 30% to 40% under the premise of accurate evaluation;(3)There was no tumor thrombus in hepatic vein,portal vein.