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BACKGROUND: Accurate assessment of resection volume and vascular anatomy is mandatory in preoperative planning for safe and curative hepatectomy to treat cancer. Accordingly, we examined feasibility and accuracy of a preoperative three-dimensional (3D) computed tomography (CT) scan based simulation in patients with impaired liver function undergoing hepatectomy for hepatocellular carcinoma (HCC). METHODS: Hepatectomy simulation software was programmed to reconstruct detailed 3D vascular structure and calculate liver volume based on hepatic circulation. In 113 patients with HCC, liver resection volume was estimated preoperatively by both simulation and conventional planimetry. For validation, predicted resection volumes were compared with actual resected specimen weights. The resection margin as estimated by the simulation was compared with the margin in the specimen. RESULTS: Simulation showed higher correlation and smaller discrepancy (r = 0.96; 9.3 ml) between predicted and actual liver resection volume than conventional planimetry (r = 0.74; 174 ml). Simulation showed correlation (p < 0.01) between estimated and actual segmental volume, which was not measurable by planimetry. Simulation showed a correlation (r = 0.84) between predicted and actual margin, with a difference of 1.6 mm. CONCLUSIONS: Hepatectomy simulation in 3D predicted segmental liver volume and the resection margin accurately. This virtual method should contribute to preoperative planning to achieve safe, curative resection in HCC patients, whose hepatic function is compromised.
Yamanaka et al. (Wed,) studied this question.