Usefulness of three-dimensional computed tomography for anatomic liver resection: sub-subsegmentectomy

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Medical imaging

Background:

• Precise subtotal hepatectomies require detailed understanding of liver vascular anatomy.
• Preoperative three-dimensional computed tomography (3D-CT) offers advanced visualization capabilities.
• Assessing the utility of 3D-CT in guiding liver resections is crucial for surgical planning.

Purpose of the Study:

• To evaluate the usefulness of three-dimensional computed tomography (3D-CT) in guiding precise subtotal hepatectomies.
• To compare the accuracy of 3D-CT with conventional CT in tumor localization for liver cancer surgery.

Main Methods:

• Retrospective review of clinical records and 3D-CT images from 20 patients with 24 hepatomas (<50 mm).
• Hepatectomy procedures for hepatocellular carcinoma and metastatic tumors were analyzed.
• Liver segmentation based on Couinaud's and Takayasu's classifications was used.

Main Results:

• 3D-CT achieved 100% accuracy in tumor localization, compared to 75% for conventional CT (p < 0.05).
• 3D-CT facilitated complete tumor resection within the portal unit, even in patients with poor liver function.
• Preservation of remnant liver circulation was enhanced, leading to reduced postoperative complications.

Conclusions:

• 3D-CT provides superior diagnostic accuracy and realistic virtual imaging for liver tumor location.
• This technique enables precise anatomic liver resection, crucial for minimizing complications like bile leakage.
• 3D-CT is particularly valuable for hepatectomy, especially sub-subsegmentectomies.