Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Wenying , OUYANG Zaixing , ZHU Jianhua , WU Liming , TAN Yong , SONG Hao , ZHU Yuzhen ,  HUANG Congyun

Department of Hepatobiliary Surgery, Yuebei People’s Hospital of Shantou University Medical College, Shaoguan, Guangdong 512025, P. R. China;

Corresponding author：

HUANG Congyun, Email: hcy804@qq.com

Keywords：

three-dimensional imaging; three-dimensional printing; augmented reality; huge hepatocellular carcinoma; precise hepatectomy

DOI：

10.7507/1007-9424.202112070

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma (HCC). Methods The clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The three-dimensional (3D) reconstruction, 3D visualization, 3D printing, and augmented reality (AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode, operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. Results There were 23 patients in this study, including 18 males and 5 females, with (56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was (865.2±165.6) mL and the virtual resected liver volume was (1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was (298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was (330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation (P<0.05), and then which began to rise on the third day and basically rose to the normal range; prothrombintime, total bilirubin, alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation (P<0.05), then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases. Conclusion From preliminary results of this study, it could improve surgical safety and precision of hepatectomy for huge HCC by preoperative precise assessment and operation navigation in good time of multimode imaging technology.

Citation： LIU Wenying, OUYANG Zaixing, ZHU Jianhua, WU Liming, TAN Yong, SONG Hao, ZHU Yuzhen, HUANG Congyun. Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1207-1212. doi: 10.7507/1007-9424.202112070 Copy

1.	钟坤雨, 鞠蔚华, 刘江伟, 等. 巨大肝癌的外科治疗策略. 中国肝脏病杂志(电子版), 2019, 11(1): 1-5.
2.	Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.
3.	van Mierlo KM, Schaap FG, Dejong CH, et al. Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol, 2016, 65(6): 1217-1231.
4.	杨连粤. 孤立性大肝癌的外科治疗进展. 中华外科杂志, 2020, 58(1): 13-16.
5.	Fang Q, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China. Hepatobiliary Pancreat Dis Int, 2019, 18(6): 532-537.
6.	Chierici A, Ofosu A, Cincione I, et al. Transarterial chemoembolization as adjuvant treatment after surgery: the cure of huge hepatocellular carcinoma? Hepatobiliary Pancreat Dis Int, 2021, 20(3): 205-206.
7.	赖子森, 周阳, 林新居, 等. 巨块型肝癌的精准肝切除术. 吉林医药学院学报, 2019, 40(5): 339-341.
8.	中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会临床精准医学专业委员会, 等. 复杂性肝脏肿瘤三维可视化精准诊治指南(2019版). 中国实用外科杂志, 2019, 39(8): 766-774.
9.	杨剑, 王壮雄, 方驰华. 多模态影像技术在原发性肝癌外科中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(1): 1-5.
10.	Chen H, He Y, Jia W. Precise hepatectomy in the intelligent digital era. Int J Biol Sci, 2020, 16(3): 365-373.
11.	蔡伟, 向飞, 黄耀欢, 等. 三维可视化技术在巨块型肝癌可切除性评估及手术规划中的应用价值. 中华消化外科杂志, 2017, 16(1): 53-58.
12.	荚卫东, 陈浩, 葛勇胜, 等. 三维可视化技术在巨块型肝细胞癌精准肝切除中的应用价值. 中华肝脏外科手术学电子杂志, 2018, 7(1): 35-39.
13.	Yang LY, Fang F, Ou DP, et al. Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg, 2009, 249(1): 118-123.
14.	Benson AB, D’Angelica MI, Abbott DE, et al. NCCN Guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
15.	Wang L, Liu Z, Liu X, et al. The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors: a meta analysis. Medicine (Baltimore), 2017, 96(52): e9226. doi: 10.1097/MD.0000000000009226.
16.	Fang C, Zhang P, Qi X. Digital and intelligent liver surgery in the new era: prospects and dilemmas. EBioMedicine, 2019, 41: 693-701.
17.	Fang C, An J, Bruno A, et al. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int, 2020, 14(4): 437-453.
18.	方驰华, 赵东, 曾思略. 以血管为轴心的巨块型肝脏肿瘤三维可视化术前规划和诊疗. 腹部外科, 2018, 31(5): 299-301, 305.
19.	张鹏, 祝文, 方驰华, 等. 多模影像技术在解剖性肝切除手术导航中应用价值研究. 中国实用外科杂志, 2019, 39(5): 480-486.
20.	Memeo R, de’Angelis N, de Blasi V, et al. Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol, 2016, 8(13): 591-596.
21.	王壮雄, 李林容, 王芳元, 等. 虚拟和增强现实技术在肝脏外科中的应用. 实用医学杂志, 2018, 34(7): 1210-1212.
22.	Zhang W, Zhu W, Yang J, et al. Augmented reality navigation for stereoscopic laparoscopic anatomical hepatectomy of primary liver cancer: preliminary experience. Front Oncol, 2021, 11: 663236. doi: 10.3389/fonc.2021.663236.
23.	Lang H, Huber T. Virtual and augmented reality in liver surgery. Ann Surg, 2020, 271(1): e8. doi: 10.1097/SLA.0000000000003601.
24.	方驰华, 田捷, 张鹏, 等. 数字医学技术在肝胆胰外科的应用: 20年历史回顾与未来展望. 中华外科杂志, 2021, 59(10): 807-811.

1. 钟坤雨, 鞠蔚华, 刘江伟, 等. 巨大肝癌的外科治疗策略. 中国肝脏病杂志(电子版), 2019, 11(1): 1-5.
2. Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.
3. van Mierlo KM, Schaap FG, Dejong CH, et al. Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol, 2016, 65(6): 1217-1231.
4. 杨连粤. 孤立性大肝癌的外科治疗进展. 中华外科杂志, 2020, 58(1): 13-16.
5. Fang Q, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China. Hepatobiliary Pancreat Dis Int, 2019, 18(6): 532-537.
6. Chierici A, Ofosu A, Cincione I, et al. Transarterial chemoembolization as adjuvant treatment after surgery: the cure of huge hepatocellular carcinoma? Hepatobiliary Pancreat Dis Int, 2021, 20(3): 205-206.
7. 赖子森, 周阳, 林新居, 等. 巨块型肝癌的精准肝切除术. 吉林医药学院学报, 2019, 40(5): 339-341.
8. 中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会临床精准医学专业委员会, 等. 复杂性肝脏肿瘤三维可视化精准诊治指南(2019版). 中国实用外科杂志, 2019, 39(8): 766-774.
9. 杨剑, 王壮雄, 方驰华. 多模态影像技术在原发性肝癌外科中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(1): 1-5.
10. Chen H, He Y, Jia W. Precise hepatectomy in the intelligent digital era. Int J Biol Sci, 2020, 16(3): 365-373.
11. 蔡伟, 向飞, 黄耀欢, 等. 三维可视化技术在巨块型肝癌可切除性评估及手术规划中的应用价值. 中华消化外科杂志, 2017, 16(1): 53-58.
12. 荚卫东, 陈浩, 葛勇胜, 等. 三维可视化技术在巨块型肝细胞癌精准肝切除中的应用价值. 中华肝脏外科手术学电子杂志, 2018, 7(1): 35-39.
13. Yang LY, Fang F, Ou DP, et al. Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg, 2009, 249(1): 118-123.
14. Benson AB, D’Angelica MI, Abbott DE, et al. NCCN Guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
15. Wang L, Liu Z, Liu X, et al. The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors: a meta analysis. Medicine (Baltimore), 2017, 96(52): e9226. doi: 10.1097/MD.0000000000009226.
16. Fang C, Zhang P, Qi X. Digital and intelligent liver surgery in the new era: prospects and dilemmas. EBioMedicine, 2019, 41: 693-701.
17. Fang C, An J, Bruno A, et al. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int, 2020, 14(4): 437-453.
18. 方驰华, 赵东, 曾思略. 以血管为轴心的巨块型肝脏肿瘤三维可视化术前规划和诊疗. 腹部外科, 2018, 31(5): 299-301, 305.
19. 张鹏, 祝文, 方驰华, 等. 多模影像技术在解剖性肝切除手术导航中应用价值研究. 中国实用外科杂志, 2019, 39(5): 480-486.
20. Memeo R, de’Angelis N, de Blasi V, et al. Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol, 2016, 8(13): 591-596.
21. 王壮雄, 李林容, 王芳元, 等. 虚拟和增强现实技术在肝脏外科中的应用. 实用医学杂志, 2018, 34(7): 1210-1212.
22. Zhang W, Zhu W, Yang J, et al. Augmented reality navigation for stereoscopic laparoscopic anatomical hepatectomy of primary liver cancer: preliminary experience. Front Oncol, 2021, 11: 663236. doi: 10.3389/fonc.2021.663236.
23. Lang H, Huber T. Virtual and augmented reality in liver surgery. Ann Surg, 2020, 271(1): e8. doi: 10.1097/SLA.0000000000003601.
24. 方驰华, 田捷, 张鹏, 等. 数字医学技术在肝胆胰外科的应用: 20年历史回顾与未来展望. 中华外科杂志, 2021, 59(10): 807-811.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content