Anatomic resection of liver cancer based on 3-D imaging system / 中华普通外科杂志

ABSTRACT

Objective To evaluate three-dimensional (3D) image of intrahepatic vessels in anatomic local resection of hepatocellular carcinoma (HCC). Methods The two-dimensional (2D) image date sets of the liver of a HCC patient, obtained by 64 row helical CT scan, were transmitted to a 3D simulation system for 3D reconstruction of intrahepafic vessels. Under the guidance of these 3D images, an actual local resection for HCC was performed. Results (1) The integrated 3D images of the hepatic artery, portal vein, hepatic vein as well as liver parenchyma and tumor were reconstructed, which visualized the detailed 3D vascular structure in the area of the tumor. (2) On the 3D images, the different cutting planes of hepatic artery, portal vein and hepatic vein were marked corresponding to different surgical margins and the involved liver volumes were calculated. (3) By balancing between the surgical margins and the liver volumes to be resected, the cutting points of hepatic artery, portal vein and hepatic vein were selected, which determined the transection plane for local resection of the HCC. (4) Based on the preoperative planning, a local resection for HCC was successfully performed with a resected specimen volume of 178 ml and a surgical circumferential margin of 9ram, which were highly in accordance with the simulating results. Conclusions Preoperative 3D imaging to visualize the anatomic structures of the tumor region make it possible to perform tumor local resection anatomically and preoperative simulation is of great value in determining an optimal transecting plane during the process of hepatectomy.