Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4607-4619
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4607
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
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, Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China
Author contributions: Tian F and Wu JX performed the majority of the experiments; Rong WQ, Wang LM, Wu F and Yu WB provided vital reagents and analytical tools and were also involved in editing the manuscript; An SL, Liu FQ, Feng L, Bi C and Liu YH collected all the clinical data and pathologic specimens; Tian F and Wu JX designed the study and wrote the manuscript.
Ethics approval: This study was reviewed and approved by the Ethical Committee of the Cancer Institute and Hospital of the Chinese Academy of Medical Science and was performed in accordance with principles of Good Clinical Practice and Declaration of Helsinki guidelines (1975, revised in 1983).
Informed consent: All study participants, or their legal guardians, were provided written informed consent prior to study enrollment.
Conflict-of-interest: We have no financial relationship with other people or organizations that can inappropriately influence our work.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Xiong Wu, MD, Abdominal Surgery Department, Cancer Institute and Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, China. xiaonao666333@126.com
Telephone: +86-10-87787100 Fax: +86-10-87787103
Received: September 11, 2014
Peer-review started: September 11, 2014
First decision: October 29, 2014
Revised: November 24, 2014
Accepted: December 13, 2014
Article in press: December 16, 2014
Published online: April 21, 2015
Processing time: 221 Days and 14 Hours
Abstract

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 custom-developed software. CT images were used for the 3D reconstruction of Couinaud’s pedicles and hepatic veins, and the calculation of corresponding tumor 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, 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.

Keywords: Centrally located; Hepatectomy; Hepatocellular carcinoma; Liver; Three-dimensional model

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.