Conventional Multi-Planar Reconstruction Imaging Is Insufficient to Determine the Indication for Segmentectomy

Area of Science:

• Hepatobiliary Surgery
• Medical Imaging
• Surgical Oncology

Background:

• Accurate assessment of tumor margins is critical for successful liver segmentectomy.
• Conventional multi-planar reconstruction (MPR) imaging is widely used for surgical planning.
• The reliability of MPR in determining tumor-to-intersegmental plane distances is not fully established.

Purpose of the Study:

• To evaluate the diagnostic accuracy of MPR imaging in estimating anatomical margins for liver segmentectomy.
• To identify specific tumor locations where MPR may lead to overestimation of surgical margins.
• To assess the validity of MPR-based decision-making for segmentectomy eligibility.

Main Methods:

• Retrospective analysis of 33 patients eligible for segmentectomy based on MPR.
• Comparison of MPR-based margin assessment with a commercially available image-analysis software.
• Verification of surgical decision-making accuracy.

Main Results:

• MPR imaging overestimated the anatomical margin in 24% (8/33) of patients.
• Overestimation was more frequent in tumors located in segments with complex or oblique intersegmental planes (right S1, S2, S3; left S3, S4).
• Specific segment locations were identified as high-risk for margin overestimation.

Conclusions:

• Conventional MPR imaging frequently overestimates anatomical margins for liver segmentectomy.
• Preoperative software-based assessment is recommended for patients with tumors in high-risk segments.
• Software-based assessment is particularly important for indistinct tumors to ensure accurate surgical planning.