Abstract: Objective:To investigate the application value of threedimensional (3D) visualization technology in the resectability assessment and surgical planning for huge hepatic carcinoma.
Methods:The retrospective crosssectional study was conducted. The clinical data of 48 patients with huge hepatic carcinoma who were admitted to the Zhujiang Hospital of Southern Medical University between January 2012 and June 2015 were collected. The preoperative image of computed tomography (CT) was converted to 3D reconstruction, visual observations and simulated surgery for assessing the tumor resectability through MI-3DVS, and corresponding treatments were performed according to the results of assessment. Observation indicators: (1) 3D reconstruction situations; (2) tumor resectability assessment through simulated surgery: tumor diameter, tumor volume, preoperative standard liver volume (SLV), tumorfree liver volume after simulated resection, future liver remnant (FLR) after simulated resection, hepatic resection rate (HRR); (3) surgical and postoperative situations: surgical procedures, resection extent, operation time, volume of intraoperative blood loss, complications, duration of postoperative hospital stay; (4) typical case analysis; (5) followup. Followup using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to June 2016. Measurement data with normal distribution were represented as ±s.
Results:(1) ThreeD reconstruction situations: 48 patients with huge hepatic carcinoma received successful 3D reconstruction and visual observations. Portal vein branches and hepatic vein branches reached level 4 through 3D reconstruction, and spacial position relationship between tumor and intrahepatic vascular backbones or branches can be clearly observed, as well as location and degree of vascular compression and invasion. (2) Tumor resectability assessment through simulated surgery: of 48 patients receiving simulated hepatectomy, 26 underwent hepatectomy and 22 didn′t undergo hepatectomy based on the assessment of resectability. Tumor diameter, tumor volume, preoperative SLV, tumorfree liver volume after simulated resection, FLR after simulated resection and HRR through assessment of 3D reconstruction and simulated surgery were (12.3±2.0)cm, (838±284)mL, (1 884± 391)mL, (494±140)mL, (551±184)mL, 46%±12% in 26 patients with resectable tumor and (14.0±2.0)cm, (1 877± 1 240)mL, (2 945±1 194)mL, (666±206)mL, (402±86)mL, 62%±9% in 22 patients with unresectable tumor, respectively. (3) Surgical and postoperative situations: 26 patients with resectable tumor underwent hepatectomy, without occurrence of death. Of 26 patients, 21 underwent anatomic hepatectomy, including 12 undergoing right hemihepatectomy, 3 undergoing left hemihepatectomy, 2 undergoing right lobectomy of the liver, 2 undergoing right posterior lobectomy of the liver, 1 undergoing left lobectomy of the liver and 1 undergoing resection of hepatic segment Ⅴ+Ⅵ. And 5 underwent nonanatomic hepatectomy, including 2 with reduced right hemihepatectomy, 1 with resection of hepatic segment Ⅱ+Ⅲ and partial segment Ⅳ, 1 with resection of hepatic segment Ⅵ +Ⅶ and partial segment Ⅴ and 1 with resection of hepatic segment Ⅴ+Ⅵ and partial segment Ⅶ. Operation time and volume of intraoperative blood loss in 26 patients were respectively (6.4±1.3)hours and (712±633)mL. Three patients with postoperative pleural effusion and 1 with postoperative bile leakage were cured by symptomatic treatment, without the occurrence of hepatic dysfunction. Duration of postoperative hospital stay was (19±8)days. Of 22 patients with unresectable tumor, 14 underwent transcatheter hepatic arterial chemoembolization (TACE), 4 underwent portal vein ligation, 1 underwent portal vein embolization and 3 abandoned treatment. (4) Typical case analysis: results of 3D reconstruction through MI-3DVS showed that patients underwent portal vein right anterior branchpreserving expanded right posterior lobectomy of the liver, with a smooth recovery. Patients were followed up for 14.0 months, with a good survival and without tumor recurrence and metastasis. (5) Followup: 40 of 48 patients were followed up for 6.0-33.0 months with a median time of 13.0 months, including 26 with surgery and 14 without surgery. During the followup, the median survival time of patients with and without surgery was 20.0 months and 10.5 months, respectively. Twelve patients with surgery had tumor recurrence and metastasis.
Conclusion:Threedimensional visualization technology is safe and feasible in the resectability assessment and surgical planning for huge hepatic carcinoma, and it will benefit to reduce risk of surgery.