Precise Hepatectomy for Primary Hepatocellular Carcinoma (Report of 32 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Congyun ¹ , CHEN Zhensong ² , SUN Junqi ² , ZHANG Xiaolong ¹ , ZHU Jianhua ¹ , WU Qingsong ¹ , ZHAO Jiafeng ¹ , LIU Ganhui ² , WAN Zhifang ²

1.Department of Hepatobiliary Surgery， The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan 512026, Guangdong Province, China;;
2.Department of Radiology, The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan 512026, Guangdong Province, China;

Corresponding author：

Keywords：

Hepatocellular carcinoma; Precise hepatectomy; Magnetic resonance image; Three-dimensional reconstruction; Survival rate

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Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites ( gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.

Citation： HUANG Congyun,CHEN Zhensong,SUN Junqi,ZHANG Xiaolong,ZHU Jianhua,WU Qingsong,ZHAO Jiafeng,LIU Ganhui,WAN Zhifang. Precise Hepatectomy for Primary Hepatocellular Carcinoma (Report of 32 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 532-537. doi: Copy

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11.	徐庆祥, 丁义涛. 精确肝切除术的临床应用 [J]. 中华肝胆外科杂志, 2009； 15(3): 166-169.
12.	Fan ST. Precise hepatectomy guided by the middle hepatic vein [J]. Hepatobiliary Pancreat Dis Int, 2007； 6(4): 430-434.
13.	Chun YS, Ribero D, Abdalla EK, et al. Comparison of two methods of future liver remnant volume measurement [J]. J Gastrointest Surg, 2008； 12(1): 123-128.
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17.	黄从云, 彭淑牖. 肝后间隙的解剖和临床意义 [J]. 国外医学·外科学分册, 2005； 32(5): 343-346.
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1. Gertsch P, Vandoni RE, Pelloni A, et al. Localized hepatic ischemia after liver resection: a prospective evaluation [J]. Ann Surg， 2007； 246(6): 958-965.
2. Mutter D, Dallemagne B, Bailey Ch, et al. 3D virtual reality and selective vascular control for laparoscopic left hepatic lobectomy [J]. Surg Endosc, 2009； 23(2): 432-435.
3. 董家鸿, 杨世忠, 段伟东, 等. 精准肝脏外科技术在复杂肝脏占位性病变切除中的应用 [J]. 中华外科杂志, 2009； 47(21): 1610-1615.
4. 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.
5. Beller S, Hünerbein M, Eulenstein S, et al. Feasibility of navigated resection of liver tumors using multiplanar visualization of intraoperative 3-dimensional ultrasound data [J]. Ann Surg, 2007； 246(2): 288-294.
6. Lang H, Radtke A, Hindennach M, et al. Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection [J]. Arch Surg, 2005； 140(7): 629-638.
7. 王义, 张友磊, Heinz-Otto P, 等. 肝脏CT扫描后三维重建在肝切除手术计划中的初步应用 [J]. 中华外科杂志, 2008； 46(24): 1931-1933.
8. 黄从云, 孟志华, 陈振松, 等. 虚拟肝切除技术在肝癌切除中的临床应用 [J].中华肝胆外科杂志， 2010；16(4): 249-252.
9. 陈刚, 李学成, 熊晓峰, 等. 肝脏虚拟手术系统在肝右叶肿瘤手术中的临床应用 [J]. 中国普外基础与临床杂志, 2010； 17(1): 64-67.
10. Wakabayashi H, Ishimura K, Izuishi K, et al. Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver with damaged parenchyma [J]. J Surg Res, 2004； 116(2): 248-252.
11. 徐庆祥, 丁义涛. 精确肝切除术的临床应用 [J]. 中华肝胆外科杂志, 2009； 15(3): 166-169.
12. Fan ST. Precise hepatectomy guided by the middle hepatic vein [J]. Hepatobiliary Pancreat Dis Int, 2007； 6(4): 430-434.
13. Chun YS, Ribero D, Abdalla EK, et al. Comparison of two methods of future liver remnant volume measurement [J]. J Gastrointest Surg, 2008； 12(1): 123-128.
14. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection [J]. J Gastrointest Surg, 2003； 7(3): 325-330.
15. 孙惠川, 汤敏, 钦伦秀, 等. 用余肝体积预测半肝切除耐受性的安全标准 [J]. 中华肝胆外科杂志, 2006； 12(6): 366-369.
16. Lee SG, Hwang S. How I do it: assessment of hepatic functional reserve for indication of hepatic resection [J]. J Hepatobiliary Pancreat Surg, 2005； 12(1): 38-43.
17. 黄从云, 彭淑牖. 肝后间隙的解剖和临床意义 [J]. 国外医学·外科学分册, 2005； 32(5): 343-346.
18. Scatton O, Plasse M, Dondero F, et al. Impact of localized congestion related to venous deprivation after hepatectomy [J]. Surgery, 2008； 143(4): 483-489.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Precise Hepatectomy for Primary Hepatocellular Carcinoma (Report of 32 Cases)

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