Application of a three-dimensional reconstruction technique in safety assessment of hemihepatectomy for huge hepatic tumor

Abstract

Introduction: The purpose of this study was to determine the clinical value of three-dimensional computer reconstruction technique in preoperative safety assessment of hemihepatectomy for huge hepatic tumor. Methods: 108 patients who underwent hemihepatectomy of two groups (tumor diameter ≥10cm vs.< 10cm) were subjected to preoperative hepatectomy simulation by IQQA-Liver software. Liver volume (LV), standard liver volume (SLV), tumor volume (TV), functional liver volume (FLV=LV-TV), excised liver volume (ELV), excised functional liver volume (EFLV) and residual liver volume (RLV) were calculated. The ratio of total liver resection as ELV/LV, the ratio of functional liver resection as EFLV/FLV, and the relative amount of future liver remnant as RLV/FLV and RLV/SLV were compared between two groups. Results: Simulation showed high correlation (r = 0.994, p< 0.001) and accuracy between ELV and actual ELV. The EFLV/FLV was significantly smaller (p< 0.01) in the group of tumor ≥10cm than that < 10cm, either in the right hemihepatectomy subgroup or in the left hemihepatectomy subgroup. However, the RLV/FLV was significantly lager (p< 0.01) in the group of tumor ≥10cm than that < 10cm, and RLV/SLV was not different (p>0.05). 25 patients had RLV/LV < 30%, but only one patient had RLV/SLV < 30%. Majority of the patients had RLV/FLV and RLV/SLV >40% (97.2% and 98.1%, respectively). No patients suffered postoperative liver failure or death in both groups. Conclusion: Our results indicated in the same extent of anatomical hepatectomy, the lager the tumor is, the less functional liver tissue will be resected, and greater tumor free residual volume will be remained.