Multimodal threedimensional resection planning for extended liver resection in a severe case of Echinococcus multilocularis

Abstract

Background: Liver infections of Echinococcus multilocularis (EM) are rare in Germany. The optimal therapy of EM is surgical liver resection similar to malignant tumors. Methods: We describe the case of a 22-year-old patient who was diagnosed with increased liver enzymes during a routine checkup. Further radiologic diagnostics revealed an extended, cystic tumor of the liver with infiltration of left and middle hepatic vein and close contact to the right hepatic vein (RHV) and the inferior vena cava (VCI). Serologic tests confirmed the infection with EM. The patient was referred with the question of resectability after primary azole treatment. For a better preoperative evaluation, we performed a 3D reconstruction and resection planning. We combined this with 3D printing of the liver and the virtual display of the reconstruction in a virtual reality head mounted display (VR-HMD). For a curative and functional operation, resection of the VCI and reconstruction of the RHV seemed the only possibility. Results: We performed extended left hepatectomy with resection of segment 1, the extrahepatic bile duct, partial resection of the VCI and reconstruction with pericardial patch and end-to-end anastomosis of the segmentally resected RHV. The tumor was completely resected and histopathological analysis confirmed EM. Conclusion: In extended cases, the use of 3D reconstruction in combination with latest display methods such as VR-HMD or 3D printed models can improve surgical liver resection planning.