Application of preoperative accurate define of liver transection plane in ALPPS based on 3D visualization technology

Abstract

Objective To explore the application value of preoperative accurate define of liver transection plane with three-dimensional (3D) visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods Clinical data of 9 patients undergoing ALPPS in the Second Affiliated Hospital of Air Force Medical University from March 2015 to May 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 2 female, aged (54±10) years on average. 3D model of liver of the patients was reconstructed using Myrian software. The future liver remnant (FLR) was assessed before operation by liver division of Robin Smithuis & Eduard E. De Lange imaging (RE division) and precise division, respectively. Precise division focuses on the tumor cutting margin on the base of RE division. The FLR obtained by two methods was statistically compared by using paired t test. Results The FLR of RE division was (419±144) ml, significantly larger than (403±135) ml of precise division (t=2.51, P=0.036). The FLR difference value between two methods accounted for 0.2%-4.5% of standard liver volume (SLV). For1 patient, the FLR/SLV ratio was calculated as 44.3% (above 40%) by RE division, while 39.8% (below 40%) by precise division. Among 9 patients, 7 cases underwent ALPPS successfully including 6 cases of extended right hepatectomy and 1 case of right hepatectomy. The remaining 2 cases failed to undergo the second-stage operation. Conclusions The single imaging liver division method may have some errors. Prior to ALPPS, surgeons should combine imaging liver plane with the dividing line of liver lobes and follow the principle of liver cancer resection in order to accurately define the transection plane based on 3D visualization technology. Key words: Hepatectomy; Imaging, three-dimensional; Carcinoma, hepatocellular; Bile duct neoplasms