Application of lasting methylene blue staining and three-dimensional reconstruction in precise anatomic hepatectomy for patients with liver cancer

Abstract

Objective To investigate the application value of lasting methylene blue staining and three-dimensional reconstruction in precise anatomic hepatectomy for patients with liver cancer. Methods From January 2015 to December 2017, one hundred and thirty-four patients with liver cancer in the 901st Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army were enrolled. Three-phase enhanced CT or MRI were performed before operation, and three-dimensional reconstruction of portal vein, hepatic artery and hepatic vein was completed by MeVis software. Fifty-four patients underwent lasting methylene blue staining combined with precise anatomical hepatectomy (combined group, dosage of methylene blue was 4 ml per hepatic segment), and 80 patients underwent precise anatomical hepatectomy alone (control group). The perioperative indicators and 1-year cumulative survival rate were compared between the two groups after follow-up until December 2018. Results In the combined group, 53 cases (98.15%) had the same intraoperative liver staining as hepatic angiography. Compared with the control group, patients of the combined group had longer operation time and less bleeding during operation (t=7.424, 2.923; P=0.009, 0.023). There were no significant differences in the time of hepatic hilar occlusion, incidence of complications between the two groups (t=0.317, P=0.261; 18.52% vs 17.50%, χ2=0.016, P=0.900). Tumor margins were negative in both groups. There was no significant difference in the average hospitalization time between the combined group and the control group [(7.45±3.17) d vs (6.64±4.36) d, t=1.172, P=0.331]. The abdominal drainage volume in the combined group was less than that in the control group two days before operation, and the difference was significant (t=5.382, 4.944; P=0.015, 0.033). Compared with the combined group, the serum alanine aminotransferase and total bilirubin levels in the control group were significantly higher on the 1st, 3rd day after operation, while the albumin levels were significantly lower on the 1st, 3rd and 5th day after operation (all P<0.05). There was no significant difference in 1-year cumulative survival rate between the two groups (90% vs 89%, P=0.806). Conclusion The lasting methylene blue staining can improve the accuracy of anatomic hepatectomy and reduce the intraoperative blood loss, which is conductive to making clear the liver segmental boundaries and improving the accuracy of operative section selection. Key words: Liver neoplasms; Staining and labeling; Methylene blue; Precise hepatectomy; Three-dimensional reconstruction