title: Toward knowledge-based liver surgery: holistic information processing for surgical decision support.
abstract: OBJECTIVE
  Malignant neoplasms of the liver are among the most frequent cancers worldwide. Given the diversity of options for liver cancer therapy, the choice of treatment depends on various parameters including patient condition, tumor size and location, liver function, and previous interventions. To address this issue, we present the first approach to treatment strategy planning based on holistic processing of patient-individual data, practical knowledge (i.e., case knowledge), and factual knowledge (e.g., clinical guidelines and studies).
  
  
  METHODS
  The contributions of this paper are as follows: (1) a formalized dynamic patient model that incorporates all the heterogeneous data acquired for a specific patient in the whole course of disease treatment; (2) a concept for formalizing factual knowledge; and (3) a technical infrastructure that enables storing, accessing, and processing of heterogeneous data to support clinical decision making.
  
  
  RESULTS
  Our patient model, which currently covers 602 patient-individual parameters, was successfully instantiated for 184 patients. It was sufficiently comprehensive to serve as the basis for the formalization of a total of 72 rules extracted from studies on patients with colorectal liver metastases or hepatocellular carcinoma. For a subset of 70 patients with these diagnoses, the system derived an average of [Formula: see text] assertions per patient.
  
  
  CONCLUSIONS
  The proposed concept paves the way for holistic treatment strategy planning by enabling joint storing and processing of heterogeneous data from various information sources.
authors.affiliation: Department of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany, k.maerz@dkfz.de.
authors.forename: K
authors.initials: K
authors.lastname: März
authors.forename: M
authors.initials: M
authors.lastname: Hafezi
authors.forename: T
authors.initials: T
authors.lastname: Weller
authors.forename: A
authors.initials: A
authors.lastname: Saffari
authors.forename: M
authors.initials: M
authors.lastname: Nolden
authors.forename: N
authors.initials: N
authors.lastname: Fard
authors.forename: A
authors.initials: A
authors.lastname: Majlesara
authors.forename: S
authors.initials: S
authors.lastname: Zelzer
authors.forename: M
authors.initials: M
authors.lastname: Maleshkova
authors.forename: M
authors.initials: M
authors.lastname: Volovyk
authors.forename: N
authors.initials: N
authors.lastname: Gharabaghi
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: G
authors.initials: G
authors.lastname: Emami
authors.forename: S
authors.initials: S
authors.lastname: Engelhardt
authors.forename: A
authors.initials: A
authors.lastname: Fetzer
authors.forename: H
authors.initials: H
authors.lastname: Kenngott
authors.forename: N
authors.initials: N
authors.lastname: Rezai
authors.forename: A
authors.initials: A
authors.lastname: Rettinger
authors.forename: R
authors.initials: R
authors.lastname: Studer
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
authors.forename: L
authors.initials: L
authors.lastname: Maier-Hein
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D000066491:Clinical Decision-Making; D015179:Colorectal Neoplasms / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008953:Models, Anatomic
references.citation: Stud Health Technol Inform. 2008;139:22-43
references.pmid: 18806319
references.citation: J Clin Oncol. 2007 Oct 10;25(29):4575-80
references.pmid: 17925551
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S5-S16
references.pmid: 15508102
references.citation: Ann Surg. 2007 Aug;246(2):288-94
references.pmid: 17667508
references.citation: Int J Med Robot. 2011 Mar;7(1):7-16
references.pmid: 21341357
references.citation: Ann Surg. 2002 Jun;235(6):759-66
references.pmid: 12035031
references.citation: Int J Comput Assist Radiol Surg. 2013 May;8(3):419-28
references.pmid: 23054746
references.citation: J Hepatobiliary Pancreat Sci. 2013 Feb;20(2):157-64
references.pmid: 23135735
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2012;2012:3744-7
references.pmid: 23366742
references.citation: BMC Med Inform Decis Mak. 2002 May 10;2:5
references.pmid: 12003639
references.citation: Semin Intervent Radiol. 2006 Mar;23(1):47-63
references.pmid: 21326720
references.citation: Med Image Anal. 2013 Oct;17(7):790-804
references.pmid: 23725639
references.citation: Hepatology. 2009 Jul;50(1):1-2
references.pmid: 19554618
references.citation: J Biomed Inform. 2014 Dec;52:354-63
references.pmid: 25109270