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Published on: May 23, 2025
Role of CT in Two-Stage Liver Surgery.
Diego M Haberman1, Oscar C Andriani1, Nicole L Segaran1
1From the Body Imaging Section, Centro de Diagnóstico Rossi, Esmeralda 141, Buenos Aires C1035ABD, Argentina (D.M.H., M.M.V., M.L.M.); Oncosurgical HPB Unit, Sanatorio de los Arcos, Swiss Medical Group, HPB, Buenos Aires, Argentina (O.C.A., R.H.R., I.A.P.F.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.L.S.).
Multidetector CT is crucial for planning two-stage hepatectomy (TSH) by assessing liver tumor resectability and future liver remnant (FLR) hypertrophy. This imaging guides surgeons, enabling curative resection for more liver cancer patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Diagnostic Imaging
Background:
- Complete resection offers the only potential cure for liver tumors.
- Advanced surgical techniques like two-stage hepatectomy (TSH) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) enable liver resection in more patients.
- Radiologists play a key role in the multidisciplinary team for TSH.
Purpose of the Study:
- To review the critical role of multidetector CT in planning and managing two-stage hepatectomy (TSH).
- To highlight key imaging observations for surgical planning in TSH.
- To briefly describe MRI's role in liver metastasis detection and complication assessment.
Main Methods:
- Review of multidetector CT applications in TSH.
- Discussion of CT's role before and between TSH stages.
- Brief overview of MRI for liver metastases and complications.
Main Results:
- Pre-TSH CT assesses surgical feasibility, tumor location, anatomy, and FLR volume for posthepatectomy liver failure risk.
- Inter-stage CT recalculates liver volumes, evaluates FLR hypertrophy, and identifies complications impacting the surgical plan.
- CT provides essential anatomical and volumetric data for successful TSH.
Conclusions:
- Multidetector CT is indispensable for TSH, guiding surgical decisions from initial assessment to definitive resection.
- Accurate CT volumetry and anatomical evaluation are vital for ensuring sufficient FLR and preventing liver failure.
- Radiological assessment is integral to expanding curative treatment options for liver tumors through TSH.
