Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: A pilot study

Fei Tian, Jian-Xiong Wu, Wei-Qi Rong, Li-Ming Wang, Fan Wu, Wei-Bo Yu, Song-Lin An, Fa-Qiang Liu, Li Feng, Chao Bi, Yun-He Liu
2015 World Journal of Gastroenterology  
AIM: To describe a three-dimensional model (3DM) to accurately reconstruct anatomic relationships of centrally located hepatocellular carcinomas (HCCs). METHODS: From March 2013 to July 2014, reconstructions and visual simulations of centrally located HCCs were performed in 39 patients using a 3D subject-based computed tomography (CT) model with customdeveloped software. CT images were used for the 3D reconstruction of Couinaud's pedicles and hepatic veins, and the calculation of corresponding
more » ... umor territories and hepatic segments was performed using Yorktal DMIT software. The respective volume, surgical margin, and simulated virtual resection of tumors were also estimated by this model preoperatively. All patients were treated surgically and the results were retrospectively assessed. Clinical characteristics, imaging data, procedure variables, pathologic features, and postoperative data were recorded and compared to determine the reliability of the model. RESULTS : 3D reconstruction allowed stereoscopic identification of the spatial relationships between physiologic and pathologic structures, and offered quantifiable liver resection proposals based on individualized liver anatomy. The predicted values were consistent with the actual values for tumor mass volume (82.4 ± 109.1 mL vs 84.1 ± 108.9 mL, P = 0.910), surgical margin (10.1 ± 6.2 mm vs 9.1 ± 5.9 mm, P = 0.488), and maximum tumor diameter (4.61 ± 2.16 cm vs 4.53 ± 2.14 cm, P = 0.871). In addition, Retrospective Study ORIGINAL ARTICLE the number and extent of portal venous ramifications, as well as their relation to hepatic veins, were visualized. Preoperative planning based on simulated resection facilitated complete resection of large tumors located in the confluence of major vessels. And most of the predicted data were correlated with intraoperative findings. CONCLUSION: This 3DM provides quantitative morphometry of tumor masses and a stereo-relationship with adjacent structures, thus providing a promising technique for the management of centrally located HCCs. Core tip: Relatively accurate and convenient measurements of morphometric parameters of tumor masses using radiology is important for planning surgical strategy, especially for centrally located hepatic tumors, which should be individualized in each patient with the aim of preserving major vascular branches. In this study, we describe a three-dimensional model to accurately reconstruct the relationships between the tumor, hepatic veins, and Glissonian pedicles for centrally located hepatocellular carcinomas, which is essential for correctly defining the hepatic segments and the limits of tumors with wide variations in anatomy. YH. Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study. World J Gastroenterol 2015; 21(15): 4607-4619 Available from: URL
doi:10.3748/wjg.v21.i15.4607 pmid:25914470 pmcid:PMC4402308 fatcat:a3nqadkab5ekhlo7er46pdz33q