title: Preoperative 3D volumetric analysis for liver congestion applied in a patient with hilar cholangiocarcinoma.
abstract: OBJECTIVE
  Postoperative hepatic failure preceded by insufficient remnant liver function is one of the major causes of mortality. The aim of this article was to present the usefulness of preoperative three-dimensional volumetric analysis applied in liver resection to avoid congestion in the remnant liver.
  
  
  METHODS
  The patient was a 45-year-old man with hilar cholangiocarcinoma. After bilateral percutaneous biliary transhepatic drainage, left hepatic lobectomy combined with total caudectomy was planned. Large inferior right hepatic vein (IRHV) and middle right hepatic vein (MRHV) was demonstrated by multidetector row computed tomography. By analyzing with liver simulation software, total liver volume and the remnant volume were 2,519.6 and 1,849.3 cm(3), respectively. The drainage volume of each vein was as follows: middle hepatic vein = 337.5 cm(3) (18.7%, ratio to the remnant right lobe); right hepatic vein = 627.9 cm(3) (34.8%); MRHV = 187.0 cm(3) (10.4%); IRHV = 651.9 cm(3) (36.1%). If we dissect both MRHV and IRHV, 46.5% of the remnant liver becomes congested. We planned to preserve these two veins. Operation was successfully performed without congestion. This modality provides a precise image of the intrahepatic structure and enables us to evaluate the congested area. This is important for a patient with a marginal amount of remnant liver, in which even a small congestion leads to a fatal consequence.
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takahashi
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sasaki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kondo
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Oda
authors.forename: Soichiro
authors.initials: S
authors.lastname: Murata
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D021621:Imaging, Three-Dimensional; D017093:Liver Failure / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed