Application of 3D visualization technology in precise hepatectomy for complex liver tumors in infants

Abstract

Objective To investigate the application value of 3D visualization technology in precise hepatectomy for complex liver tumors in infants. Methods Clinical data of 16 infants undergoing precise hepatectomy for complex liver tumors with 3D visualization technology in the Affiliated Hospital of Qingdao University between June 2012 and January 2015 were retrospectively studied. Among the 16 infants, 10 were boys and 6 were girls with the age ranging from 22 d to 3 years old and the median of 1 year and 2 months old. Twelve patients were with giant tumors involving the corresponding porta hepatis and four patients were with primary tumor at porta hepatis. The informed consents of all infants were obtained from their parents and the local ethical committee approval had been received. The infants were examined by 64-slice spiral CT. The scanning data were imported into the computer-aided surgery system (Higemi) to perform 3D reconstruction and to compute remnant liver volume and remnant-standard liver volume ratio (RSLVR). The preoperative plan of precise hepatectomy was formulated according to the 3D reconstruction images. Results After Higemi 3D reconstruction, the intrahepatic vasculature, including the distribution, branching and spatial conformation of portal vein, hepatic artery and hepatic veins were clearly displayed. The anatomic spatial relationships between the lesions and the surrounding vascular structures could be observed at any angle, and lesions could be located and assessed accurately. The preoperative 3D reconstruction results were in accordance with the intraoperative findings. Sixteen infants underwent hepatectomy successfully according to the preoperative plan. The median RSLVR was 44.7% (21.1%-78.4%), the duration of operation was 145 (90-230) min, the intraoperative blood loss was 60 (3-100) ml and the rate of blood transfusion was 38% (6/16). One infant with giant tumor in the right liver lobe developed disseminated intravascular coagulation and died although active treatment. The other 15 infants had no complication and were discharged successfully. Conclusion For complex liver tumors of infants, 3D visualization technology can assess the tumors accurately before surgery and help to make the optimum surgical plan, which makes hepatectomy for complex liver tumors of infants more precise, safe and effective. Key words: Imaging, three-dimensional; Liver neoplasms; Hepatectomy; Infant