Validation and Application of Novel Three Dimensional Operation Planning System in Patients with Hepatocellular Carcinoma Requiring Precise Hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KUANG Ming ^1,2 , TANG Di ¹ , WANG Ye ¹ , CHEN Wei ¹ , JIANG Chunlin ¹ , REN Qingqi ¹ , PENG Baogang ¹ , LIANG Lijian ¹

1.Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yatsen University, Guangzhou 510080, Guangdong Province, China;;
2.Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yatsen University, Guangzhou 510080, Guangdong Province, China;

Corresponding author：

Keywords：

Three dimensional operation planning system; Precise hepatectomy; Liver neoplasm; Virtual hepatectomy; Preoperative evaluation

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, P lt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, P lt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.

Citation： KUANG Ming ,TANG Di,WANG Ye,CHEN Wei,JIANG Chunlin,REN Qingqi,PENG Baogang,LIANG Lijian. Validation and Application of Novel Three Dimensional Operation Planning System in Patients with Hepatocellular Carcinoma Requiring Precise Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 682-687. doi: Copy

1.	王学浩, 陆森. 肝切除技术的现状 [J]. 中国普外基础与临床杂志, 2010, 17(6): 525527.
2.	Ince N, Wands JR. The increasing incidence of hepatocellular carcinoma [J]. N Engl J Med, 1999, 340(10): 798799.
3.	Wu CC, Ho WL, Yeh DC, et al. Hepatic resection of hepatocellular carcinoma in cirrhotic livers: is it unjustified in impaired liver function? [J]. Surgery, 1996, 120(1): 3439.
4.	Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559.
5.	Frauenfelder T, Tutic M, Weder W, et al. Volumetry—an alternative to assess therapy response for malignant pleural mesothelioma? [J]. Eur Respir J, 2011, doi: 10.1183/09031936.00146110.
6.	Stephen JW, Doris NR, Xue JY, et al. Virtual hepatic resection using threedimensional reconstruction of helical computed tomography angioportograms [J]. Ann Surg, 2001, 233(2): 221226.
7.	Abdalla EK, Denys A, Chevalier P, et al. Total and segmental liver volume variations: implications for liver surgery [J]. Surgery, 2004, 135(4): 404410.
8.	Schütte K, Bornschein J, Malfertheiner P. Hepatocellular carcinoma—epidemiological trends and risk factors [J]. Dig Dis, 2009, 27(2): 8092.
9.	Van Thiel DH, Hagler NG, Schade RR, et al. In vivo hepatic volume determination using sonography and computed tomography. Validation and a comparison of the two techniques [J]. Gastroenterology, 1985, 88(6): 18121817.
10.	Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decisionmaking in resectional surgery for hepatic tumors [J]. Hepatology, 1997, 26(5): 11761181.
11.	Hiroshige S, Shimada M, Harada N, et al. Accurate preoperative estimation of livergraft volumetry using threedimensional computed tomography [J]. Transplantation, 2003, 75(9): 15611564.
12.	Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial [J]. Ann Surg, 2007, 245(1): 3643.
13.	Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304.
14.	Yamanaka J, Saito S, Fujimoto J. Impact of preoperative planning using virtual segmental volumetry on liver resection for hepatocellular carcinoma [J]. World J Surg, 2007, 31(6): 12491255.
15.	Takayasu K, Okuda K. Anatomy of the liver//Takayasu K, Okuda K, eds. Imaging in Liver Disease [M]. Oxford: Oxford University Press, 1997: 145.
16.	王宏光, 张煊, 董家鸿. 腹腔镜肝切除技术的优化 [J]. 中国普外基础与临床杂志, 2010, 17(6): 538542.
17.	Atri M, Bret PM, FraserHill MA. Intrahepatic portal venous variation: prevalence with US [J]. Radiology, 1992, 184(1): 157158.

1. 王学浩, 陆森. 肝切除技术的现状 [J]. 中国普外基础与临床杂志, 2010, 17(6): 525527.
2. Ince N, Wands JR. The increasing incidence of hepatocellular carcinoma [J]. N Engl J Med, 1999, 340(10): 798799.
3. Wu CC, Ho WL, Yeh DC, et al. Hepatic resection of hepatocellular carcinoma in cirrhotic livers: is it unjustified in impaired liver function? [J]. Surgery, 1996, 120(1): 3439.
4. Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559.
5. Frauenfelder T, Tutic M, Weder W, et al. Volumetry—an alternative to assess therapy response for malignant pleural mesothelioma? [J]. Eur Respir J, 2011, doi: 10.1183/09031936.00146110.
6. Stephen JW, Doris NR, Xue JY, et al. Virtual hepatic resection using threedimensional reconstruction of helical computed tomography angioportograms [J]. Ann Surg, 2001, 233(2): 221226.
7. Abdalla EK, Denys A, Chevalier P, et al. Total and segmental liver volume variations: implications for liver surgery [J]. Surgery, 2004, 135(4): 404410.
8. Schütte K, Bornschein J, Malfertheiner P. Hepatocellular carcinoma—epidemiological trends and risk factors [J]. Dig Dis, 2009, 27(2): 8092.
9. Van Thiel DH, Hagler NG, Schade RR, et al. In vivo hepatic volume determination using sonography and computed tomography. Validation and a comparison of the two techniques [J]. Gastroenterology, 1985, 88(6): 18121817.
10. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decisionmaking in resectional surgery for hepatic tumors [J]. Hepatology, 1997, 26(5): 11761181.
11. Hiroshige S, Shimada M, Harada N, et al. Accurate preoperative estimation of livergraft volumetry using threedimensional computed tomography [J]. Transplantation, 2003, 75(9): 15611564.
12. Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial [J]. Ann Surg, 2007, 245(1): 3643.
13. Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304.
14. Yamanaka J, Saito S, Fujimoto J. Impact of preoperative planning using virtual segmental volumetry on liver resection for hepatocellular carcinoma [J]. World J Surg, 2007, 31(6): 12491255.
15. Takayasu K, Okuda K. Anatomy of the liver//Takayasu K, Okuda K, eds. Imaging in Liver Disease [M]. Oxford: Oxford University Press, 1997: 145.
16. 王宏光, 张煊, 董家鸿. 腹腔镜肝切除技术的优化 [J]. 中国普外基础与临床杂志, 2010, 17(6): 538542.
17. Atri M, Bret PM, FraserHill MA. Intrahepatic portal venous variation: prevalence with US [J]. Radiology, 1992, 184(1): 157158.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Validation and Application of Novel Three Dimensional Operation Planning System in Patients with Hepatocellular Carcinoma Requiring Precise Hepatectomy

Abstract Full text Figures/Tables Video References Cited by

Format

Content