Three-dimensional (3D) Models Based on Pre-operative Computed Tomography Scans to Personalize the Planned Liver Surgery in Complex Cases

Abstract

Purpose: In the last two decades, an increased number of patients has been submitted to liver resection for malignancy. That was possible thank to a better knowledge of tumor biology, perioperative management as well as improvement of surgical technique. Recently, three-dimensional (3D) models visualization systems based on pre-operative imaging has been proposed to plan liver surgery in complex cases. The aim of this study was to assess the feasibility and accuracy of a 3D models for patients undergoing major/extended liver resection for malignancies. Method: The Medical Device Custom Made with Hyper Accuracy 3DTM reconstruction method was applied to preoperative computed tomography (CT) scans of patients undergoing major/extended liver resections for malignancies at our institution since February 2020. The 3D models were used to guide the liver resections, including details regarding anatomical variations of the main vessels (hepatic artery, hepatic veins and portal vein) and the bile ducts as well as their relationship with the tumor and an accurate estimation of the future remnant liver volume (FRLV). Results: A total of 17 patients were included In this preliminary study. The most frequent diagnoses were hilar cholangiocarcinoma (PH-CCA, 52.9%) and intrahepatic cholangiocarcinoma (I-CCA, 23.5%). The 3D reconstruction showed anatomical vessels’ variations in 12 (70.6%) patients that were confirmed intraoperatively. A total of 5 (29.4%) patients underwent portal resection for tumor invasion. A good to optima correspondence between the hepatectomy planned using the 3D models and the intraoperative data was found in terms of bile duct and vessels resected. With a median FRLV at the 3D reconstruction of 31%, 4 (23.5%) patients had transient post hepatectomy liver failure (PHLF) of grade A/B. The median estimated blood loss was 750 mL and the median operative time was 532 minute while the median length of stay was 12 days. In 2 (11.7%) patients the resection planned on the basis of the CT imaging was changed after the pre-operative analysis of 3D reconstructions. Conclusion: These preliminary data regarding the use of 3D models in the accurate and personalize planning of complex liver resections showed that the 3D liver reconstruction might provide useful and additional information about anatomical vessels’ variations and tumor extension. The analysis of 3D reconstructions might lead the surgeon to change the planned resection.