Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Wenying , OUYANG Zaixing , ZHU Jianhua , WU Liming , TAN Yong , SONG Hao , ZHU Yuzhen ,  HUANG Congyun

Department of Hepatobiliary Surgery, Yuebei People’s Hospital of Shantou University Medical College, Shaoguan, Guangdong 512025, P. R. China;

Corresponding?author：

HUANG Congyun, Email: hcy804@qq.com

Keywords：

three-dimensional imaging; three-dimensional printing; augmented reality; huge hepatocellular carcinoma; precise hepatectomy

DOI：

10.7507/1007-9424.202112070

Video：

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Objective To study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma (HCC). Methods The clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The three-dimensional (3D) reconstruction, 3D visualization, 3D printing, and augmented reality (AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode, operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. Results There were 23 patients in this study, including 18 males and 5 females, with (56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was (865.2±165.6) mL and the virtual resected liver volume was (1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was (298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was (330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation (P<0.05), and then which began to rise on the third day and basically rose to the normal range; prothrombintime, total bilirubin, alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation (P<0.05), then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases. Conclusion From preliminary results of this study, it could improve surgical safety and precision of hepatectomy for huge HCC by preoperative precise assessment and operation navigation in good time of multimode imaging technology.

Citation： LIU Wenying, OUYANG Zaixing, ZHU Jianhua, WU Liming, TAN Yong, SONG Hao, ZHU Yuzhen, HUANG Congyun. Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1207-1212. doi: 10.7507/1007-9424.202112070 Copy

1.	鐘坤雨, 鞠蔚華, 劉江偉, 等. 巨大肝癌的外科治療策略. 中國肝臟病雜志(電子版), 2019, 11(1): 1-5.
2.	Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.
3.	van Mierlo KM, Schaap FG, Dejong CH, et al. Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol, 2016, 65(6): 1217-1231.
4.	楊連粵. 孤立性大肝癌的外科治療進展. 中華外科雜志, 2020, 58(1): 13-16.
5.	Fang Q, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China. Hepatobiliary Pancreat Dis Int, 2019, 18(6): 532-537.
6.	Chierici A, Ofosu A, Cincione I, et al. Transarterial chemoembolization as adjuvant treatment after surgery: the cure of huge hepatocellular carcinoma? Hepatobiliary Pancreat Dis Int, 2021, 20(3): 205-206.
7.	賴子森, 周陽, 林新居, 等. 巨塊型肝癌的精準肝切除術. 吉林醫藥學院學報, 2019, 40(5): 339-341.
8.	中華醫學會數字醫學分會, 中國醫師協會肝癌專業委員會, 中國醫師協會臨床精準醫學專業委員會, 等. 復雜性肝臟腫瘤三維可視化精準診治指南(2019版). 中國實用外科雜志, 2019, 39(8): 766-774.
9.	楊劍, 王壯雄, 方馳華. 多模態影像技術在原發性肝癌外科中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(1): 1-5.
10.	Chen H, He Y, Jia W. Precise hepatectomy in the intelligent digital era. Int J Biol Sci, 2020, 16(3): 365-373.
11.	蔡偉, 向飛, 黃耀歡, 等. 三維可視化技術在巨塊型肝癌可切除性評估及手術規劃中的應用價值. 中華消化外科雜志, 2017, 16(1): 53-58.
12.	莢衛東, 陳浩, 葛勇勝, 等. 三維可視化技術在巨塊型肝細胞癌精準肝切除中的應用價值. 中華肝臟外科手術學電子雜志, 2018, 7(1): 35-39.
13.	Yang LY, Fang F, Ou DP, et al. Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg, 2009, 249(1): 118-123.
14.	Benson AB, D’Angelica MI, Abbott DE, et al. NCCN Guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
15.	Wang L, Liu Z, Liu X, et al. The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors: a meta analysis. Medicine (Baltimore), 2017, 96(52): e9226. doi: 10.1097/MD.0000000000009226.
16.	Fang C, Zhang P, Qi X. Digital and intelligent liver surgery in the new era: prospects and dilemmas. EBioMedicine, 2019, 41: 693-701.
17.	Fang C, An J, Bruno A, et al. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int, 2020, 14(4): 437-453.
18.	方馳華, 趙東, 曾思略. 以血管為軸心的巨塊型肝臟腫瘤三維可視化術前規劃和診療. 腹部外科, 2018, 31(5): 299-301, 305.
19.	張鵬, 祝文, 方馳華, 等. 多模影像技術在解剖性肝切除手術導航中應用價值研究. 中國實用外科雜志, 2019, 39(5): 480-486.
20.	Memeo R, de’Angelis N, de Blasi V, et al. Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol, 2016, 8(13): 591-596.
21.	王壯雄, 李林容, 王芳元, 等. 虛擬和增強現實技術在肝臟外科中的應用. 實用醫學雜志, 2018, 34(7): 1210-1212.
22.	Zhang W, Zhu W, Yang J, et al. Augmented reality navigation for stereoscopic laparoscopic anatomical hepatectomy of primary liver cancer: preliminary experience. Front Oncol, 2021, 11: 663236. doi: 10.3389/fonc.2021.663236.
23.	Lang H, Huber T. Virtual and augmented reality in liver surgery. Ann Surg, 2020, 271(1): e8. doi: 10.1097/SLA.0000000000003601.
24.	方馳華, 田捷, 張鵬, 等. 數字醫學技術在肝膽胰外科的應用: 20年歷史回顧與未來展望. 中華外科雜志, 2021, 59(10): 807-811.

1. 鐘坤雨, 鞠蔚華, 劉江偉, 等. 巨大肝癌的外科治療策略. 中國肝臟病雜志(電子版), 2019, 11(1): 1-5.
2. Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.
3. van Mierlo KM, Schaap FG, Dejong CH, et al. Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol, 2016, 65(6): 1217-1231.
4. 楊連粵. 孤立性大肝癌的外科治療進展. 中華外科雜志, 2020, 58(1): 13-16.
5. Fang Q, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China. Hepatobiliary Pancreat Dis Int, 2019, 18(6): 532-537.
6. Chierici A, Ofosu A, Cincione I, et al. Transarterial chemoembolization as adjuvant treatment after surgery: the cure of huge hepatocellular carcinoma? Hepatobiliary Pancreat Dis Int, 2021, 20(3): 205-206.
7. 賴子森, 周陽, 林新居, 等. 巨塊型肝癌的精準肝切除術. 吉林醫藥學院學報, 2019, 40(5): 339-341.
8. 中華醫學會數字醫學分會, 中國醫師協會肝癌專業委員會, 中國醫師協會臨床精準醫學專業委員會, 等. 復雜性肝臟腫瘤三維可視化精準診治指南(2019版). 中國實用外科雜志, 2019, 39(8): 766-774.
9. 楊劍, 王壯雄, 方馳華. 多模態影像技術在原發性肝癌外科中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(1): 1-5.
10. Chen H, He Y, Jia W. Precise hepatectomy in the intelligent digital era. Int J Biol Sci, 2020, 16(3): 365-373.
11. 蔡偉, 向飛, 黃耀歡, 等. 三維可視化技術在巨塊型肝癌可切除性評估及手術規劃中的應用價值. 中華消化外科雜志, 2017, 16(1): 53-58.
12. 莢衛東, 陳浩, 葛勇勝, 等. 三維可視化技術在巨塊型肝細胞癌精準肝切除中的應用價值. 中華肝臟外科手術學電子雜志, 2018, 7(1): 35-39.
13. Yang LY, Fang F, Ou DP, et al. Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg, 2009, 249(1): 118-123.
14. Benson AB, D’Angelica MI, Abbott DE, et al. NCCN Guidelines insights: hepatobiliary cancers, version 1. 2017. J Natl Compr Canc Netw, 2017, 15(5): 563-573.
15. Wang L, Liu Z, Liu X, et al. The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors: a meta analysis. Medicine (Baltimore), 2017, 96(52): e9226. doi: 10.1097/MD.0000000000009226.
16. Fang C, Zhang P, Qi X. Digital and intelligent liver surgery in the new era: prospects and dilemmas. EBioMedicine, 2019, 41: 693-701.
17. Fang C, An J, Bruno A, et al. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases. Hepatol Int, 2020, 14(4): 437-453.
18. 方馳華, 趙東, 曾思略. 以血管為軸心的巨塊型肝臟腫瘤三維可視化術前規劃和診療. 腹部外科, 2018, 31(5): 299-301, 305.
19. 張鵬, 祝文, 方馳華, 等. 多模影像技術在解剖性肝切除手術導航中應用價值研究. 中國實用外科雜志, 2019, 39(5): 480-486.
20. Memeo R, de’Angelis N, de Blasi V, et al. Innovative surgical approaches for hepatocellular carcinoma. World J Hepatol, 2016, 8(13): 591-596.
21. 王壯雄, 李林容, 王芳元, 等. 虛擬和增強現實技術在肝臟外科中的應用. 實用醫學雜志, 2018, 34(7): 1210-1212.
22. Zhang W, Zhu W, Yang J, et al. Augmented reality navigation for stereoscopic laparoscopic anatomical hepatectomy of primary liver cancer: preliminary experience. Front Oncol, 2021, 11: 663236. doi: 10.3389/fonc.2021.663236.
23. Lang H, Huber T. Virtual and augmented reality in liver surgery. Ann Surg, 2020, 271(1): e8. doi: 10.1097/SLA.0000000000003601.
24. 方馳華, 田捷, 張鵬, 等. 數字醫學技術在肝膽胰外科的應用: 20年歷史回顧與未來展望. 中華外科雜志, 2021, 59(10): 807-811.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma

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