title: Impact of virtual reality imaging on hepatic liver tumor resection: calculation of risk.
abstract: The risk involved in partial liver resections depends mainly on tumor localization, invasion of central vascular structures, and parenchymal function. The imaging techniques available today (computed tomography, magnetic resonance imaging) allow us to detect precisely the extent of tumor invasion and their relationship to central vessels. The various three-dimensional reconstruction techniques are helpful with regard to a virtual planning of liver resections. The calculation of remaining liver volumes subsequent to partial hepatectomies are considered to be an essential predictive parameter in terms for the development of postoperative liver failure. In a retrospective and a later consecutive, prospective clinical study we analyzed the postoperative risk in a series of 570 patients. In an univariate analysis 13 of 31 parameters showed significant values. In multivariate analysis only three parameters (partial hepatic resection rate, PHRR), gamma-glutamyltranspeptidase, and prothrombin activity) were independent parameters for predicting liver failure, generating the most significant values for the PHRR. In our experience the most comfortable and precise technique for evaluating PHRR is the b-spline technique.
authors.affiliation: Surgical Department, Ludwig Maximilian University of Munich, Klinikum Grosshadern, Germany. hrau@gch.med.uni-muenchen.de
authors.forename: H G
authors.initials: HG
authors.lastname: Rau
authors.forename: R
authors.initials: R
authors.lastname: Schauer
authors.forename: T
authors.initials: T
authors.lastname: Helmberger
authors.forename: N
authors.initials: N
authors.lastname: Holzknecht
authors.forename: B
authors.initials: B
authors.lastname: von Rückmann
authors.forename: L
authors.initials: L
authors.lastname: Meyer
authors.forename: E
authors.initials: E
authors.lastname: Buttler
authors.forename: M
authors.initials: M
authors.lastname: Kessler
authors.forename: G
authors.initials: G
authors.lastname: Zahlmann
authors.forename: D
authors.initials: D
authors.lastname: Schuhmann
authors.forename: F W
authors.initials: FW
authors.lastname: Schildberg
mesh_terms: D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D010347:Patient Care Planning; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011517:Prothrombin Time; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D005723:gamma-Glutamyltransferase