Original Article
Safety assessment of hepatectomy for huge hepatocellular carcinoma by three dimensional reconstruction technique
Lin Chen, Hongping Luo, Shuilin Dong, Xiaoping Chen
Published 2016-09-01
Cite as Chin J Surg, 2016, 54(9): 669-674. DOI: 10.3760/cma.j.issn.0529-5815.2016.09.005
Abstract
ObjectiveTo explore the effectiveness of three-dimentional(3D)reconstruction technique in safety assessment of hepatectomy for large hepatocellular carcinoma(HCC).
MethodsThe clinical records of 28 patients who underwent resection of HCC greater than 10 cm in diameter from January 2013 to December 2015 at Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology were studied retrospectively. All patients underwent enhanced computer tomography (CT), then 3D images of liver and tumor were reconstructed by uploading the CT imaging data to IQQA-Liver system. The individual surgery plan was simulated and liver volume (LV), standard liver volume(LV), tumor volume(TV), functional liver volume(FLV), excised liver volume(ELV), excised functional liver volume (EFLV), residual functional liver volume (RELV) were calculated. Simulated surgery plans were compared with actual procedures. ELV was compared with actual excised liver volume (AELV) by paired Student's t test. Postoperative complications and motility were analyzed. The correlation between TV and EFLV, RFLV, RFLV/FLV, RFLV/SLV were calculated by Spearman test.
ResultsTV ranged from 202 cm3 to 2 125 cm3, RELV ranged from 401 cm3 to 1 633 cm3.There were 13 patients whose RFLV/LV<30% and 28 patients whose RFLV/FLV>30%(34.8%-94.0%). RFLV/SLV ranged from 35.9% to 139.0%.All simulated surgery plans matched with the actual operation procedure. ELV was equal to AELV, which confirmed by the high precision of IQQA-Liver system(t=0.636, P>0.05). No severe complications (hepatic encephalopathy or liver failure) and perioperative death occurred after operation. Positive correlation was observed between TV and RFLV, TV and RFLV/FLV, TV and RFLV/SLV(r=0.641, 0.629 and 0.732, all P<0.01). Negative correlation was observed between TV and EFLV (r=-0.539, P<0.01).
Conclusions3D reconstruction technique could accurately simulate surgery procedure, calculate liver volume and evaluate the safety of hepatectomy for huge hepatocellular carcinoma. When the anatomical liver resection was performed, the larger tumor volume means the smaller excision functional liver volume and larger residual liver volume.
Key words:
Huge hepatocellular carcinoma; Hepatectomy; Three dimensional reconstruction technique
Contributor Information
Lin Chen
Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
Hongping Luo
Shuilin Dong
Xiaoping Chen
