Application of three dimensional visualization technique in preoperative planning of complex primary liver cancer

Abstract

Objective To evaluate the application value of three dimensional visualization technique in the preoperative planning of complex primary liver cancer (liver cancer). Methods Twenty-two patients with liver cancer admitted to the First and Second Affiliated Hospitals of Anhui Medical University between February 2014 and May 2015 were recruited in this prospective study. Sixteen patients were males and 6 females, aged between 24 and 84 years with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received contrast-enhanced computed tomography (CT) scan before surgery. Imaging data of thin-layer CT scan were collected. Three dimensional reconstruction was conducted by abdominal medicine image three-dimensional visualization system (MI3DVS). The tumor resectability was assessed and simulated surgery was performed before surgery. Total liver volume, tumor volume, target volume of resected liver and residual liver volume were measured. The resected specimen was weighed and compared with the target volume of resected liver. The incidence of postoperative complications was observed. The target and actual volumes of resected liver were compared using t test and the relationship between these two indexes was analyzed using Pearson's correlation analysis. Results Three dimensional reconstruction was successfully performed in all patients. Normal liver tissue, tumor tissue, hepatic artery, portal vein, intrahepatic bile duct and hepatic vein were clearly observed. The adjacent relationship between the tumor and surrounding tissues was directly and accurately visualized. Among 22 patients, 8 cases were ineligible for surgical treatment by preoperative evaluation and 14 underwent open hepatectomy. Postoperative pathological examination revealed that 10 patients were diagnosed with hepatocellular carcinoma and 4 with cholangiocarcinoma. No patients died during perioperative period. One patient was observed with a moderate quantity of hydrothorax at postoperative 3 d and 1 had incisional fat liquefaction at postoperative 7 d, and both were improved after symptomatic therapy. No severe complications, such as liver failure, hemorrhage or biliary leakage occured postoperatively. The target volume of resected liver was (552±266) ml and the actual volume of resected liver was (546±239) ml, and no significant difference was observed (t=0.430, P>0.05). Pearson's correlation analysis revealed the target and actual volumes of resected liver were correlated (r=0.982, P<0.05). Conclusions Three dimensional visualization technique is capable of clearly reflecting the anatomical relationship between liver tumor and hepatic ducts, accurately predicting the resection range of liver tumor, avoiding unnecessary open surgical exploration and enhancing the resection rate. It provides certain guidance for preoperative planning of hepatectomy in patients with complex liver cancer. Key words: Carcinoma, hepatocellular; Hepatectomy; Imaging, three-dimensional