Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: a pilot study.
OBJECTIVE
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.


CONCLUSIONS
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.
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.
Fei
F
Tian
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.
Jian-Xiong
JX
Wu
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.
Wei-Qi
WQ
Rong
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.
Li-Ming
LM
Wang
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.
Fan
F
Wu
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.
Wei-Bo
WB
Yu
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.
Song-Lin
SL
An
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.
Fa-Qiang
FQ
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.
Li
L
Feng
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.
Chao
C
Bi
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.
Yun-He
YH
Liu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003198:Computer Simulation; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden
Centrally located; Hepatectomy; Hepatocellular carcinoma; Liver; Three-dimensional model