title: How Has Virtual Hepatectomy Changed the Practice of Liver Surgery?: Experience of 1194 Virtual Hepatectomy Before Liver Resection and Living Donor Liver Transplantation.
abstract: To assess how virtual hepatectomy (VH), conducted using surgical planning software, influences the outcomes of liver surgery.
  
  
  
  Imaging technology visualizes the territories of the liver vessels, which were previously impossible. However, the clinical impact of VH has not been evaluated.
  
  
  
  From 2004 to 2013, we performed 1194 VHs preoperatively. Outcomes of living donor liver transplantation (LDLT) and hepatectomy for hepatocellular carcinoma (HCC)/colorectal liver metastases (CRLM) were compared between patients in whom VH was performed (VH) and those without VH evaluation (non-VH).
  
  
  
  In LDLT, the rate of right liver graft use was higher in the VH (62.1%) than in the non-VH (46.5%) (P < 0.01), which did not increase morbidity of donor surgery. Duration of recipient surgery in the VH in which middle hepatic vein branch reconstruction was skipped was shorter than that in the VH with venous reconstruction. Among HCC patients with impaired liver function, portal territory-oriented resection was conducted more often in the VH than in the non-VH. The 5-year disease-free survival rate for localized HCC was higher in the VH than in the non-VH (37.2% vs 23.9%; P = 0.04). In CRLM, long-term outcomes were similar in the VH and non-VH despite the larger tumor load in the VH.
  
  
  
  VH in LDLT allows double equipoise for the recipient and donor by optimizing decision-making on graft selection and venous reconstruction. VH offers a chance for radical hepatectomy even in HCC patients with impaired liver function and CRLM patients with advanced tumors, without compromising survival.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Shouichi
authors.initials: S
authors.lastname: Satou
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Kenji
authors.initials: K
authors.lastname: Miki
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D003198:Computer Simulation; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014584:User-Computer Interface; D055815:Young Adult