ObjectiveTo better understand artificial intelligence (AI) and its application in management of liver cancer.MethodThe relevant literatures about AI in the diagnosis and treatment of liver cancer in recent years were reviewed.ResultsIn terms of diagnosis, the deep learning could precisely and quickly complete the imaging localization and segmentation of the liver, which was helpful for the diagnosis, while radiomics had a high value in assisting the diagnosis of liver cancer, predicting the postoperative recurrence and long-term survival of patients with liver cancer. In regard of treatment, although it was still difficult for AI to intervene in liver surgery, it had significant advantages in formulating individualized operation scheme for patients with liver cancer, which enabled precise hepatectomy and was helpful for prediction of intraoperative bleeding. AI fusion imaging could provide assistance in operation plan making and realize the precise placement of ablation needle. AI was able to predict the tumor response or even tumor progression after interventional therapy and radiotherapy. Pathological analysis was also facilitated by AI and was able to identify some details and feature textures that were difficult to manually distinguish. For transplantation, guidance of AI on the allocation of donor livers based on hazards models helped make better use of limited organ resources. AI could be applied in prognosis prediction in almost all treatment modalities.ConclusionsAI provides more efficient and precise diagnosis, treatment support and prognosis than conventional medical process in liver cancer, generally by constructing a fully functional model based on a series of data mining methods combined with statistical analysis.
Objective To explore feasibility and effectiveness of three-dimensional (3D) printing technology in precise hepatectomy. Methods The patient was a 60-year-old woman with diagnosis of liver malignancy. The liver model was reconstructed using the IQQA Liver System (EDDA Technology, Inc. USA) based on the CT scan data. The volumes of the liver and the lesion were measured and recorded. The CT data were further digitally reconstructed by means of cloud computing and storage with RevoCloud (V1.0) Medical Imaging System. The best surgical plan was determined by the repeated virtual surgical resection with the reconstruction system, based on the corresponding resected liver volume and the remaining liver volume. Results The reconstruction of liver clearly showed that the tumor invaded the right hepatic and middle hepatic veins, as well as the anterior branch of right portal vein, which was consistent with the conclusion of CT scan. In the other hand, the right posterior branch of the portal vein was completely distributed in the segment Ⅴ and Ⅵ, while a relatively large right posterior inferior vena presented and drained segment Ⅴ and Ⅵ. The anatomic resection of segment Ⅶ, Ⅷ , and Ⅳa was completed according to the preoperative plan. The liver function kept recovering, and the patient discharged a week later. Conclusion Results of this patient show that 3D printing technology can accurately assess anatomic construction of liver and determine relationship between lesion and its surrounding tissue, which can be effectively used in precise hepatectomy.
Objective To explore surgery strategy of reoperation for type Ⅳa congenital choledochal cyst. Methods The patient was a 20-year-old female with repeated right upper abdominal pain and fever for more than 1 year and aggravation for more than 1 month, and the choledochal cyst excison was performed 15 years ago. The MRI revealed that a huge cyst located in the left lobe of liver, with multiple intrahepatic calculus. The patient was diagnosed with a type Ⅳa congenital choledochal cyst and choledochojejunostomy later and the intrahepatic dilated bile duct was untreated. Results The cystic dilatation of the intrahepatic bile duct was confirmed during the reoperation, and the multiple stones with pus formation were seen, the color of the right liver was normal and the anatomical left hemihepatectomy was performed. The original anastomosis had no stenosis then was preserved. An about 1.5 cm length of extrahepatic bile duct was dissociated from the upper of anastomosis, and the extrahepatic bile duct was cut open and explored with a choledochoscope. The T-tube drainage was performed following removing the stone. The patient recovered well and was discharged smoothly following the surgery. The cholangiography 6 weeks later revealed that the biliary tract was patency and there was no residual stone. There was no jaundice or fever afterwards. Conclusion Complete excision of choledochal cyst and hepaticoduodenostomy is widely accepted as a standard surgery for type Ⅳa congenital choledochal cyst.
ObjectiveTo review the effect and safety of enhanced recovery after surgery (ERAS) in liver transplant recipients.MethodsA comprehensive literature search of Pubmed, Embase, CNKI, etc. was performed using keywords “ERAS” or “fast track” and “liver transplantation” (cut-off date June 3, 2020). The relevant literatures on researches of ERAS in liver transplant recipients at home and abroad in recent years were summarized.ResultsERAS effectively could promote the functional recovery of postoperative food intake and physical activities through systemic perioperative measures different from conventional management among the liver transplant recipients. In addition, loads of studies had revealed that ERAS was safe for liver transplant recipients with positive effects in different dimensions such as controlling complications, shortening hospital stays, and reducing medical expenses, etc.ConclusionERAS can effectively promote functional recovery of liver transplant recipients without increasing risk.