Application value of three-dimensional visualization technique in precise hepatectomy for massive hepatocellular carcinoma

Objective To evaluate the application of three-dimensional visualization technique in precise hepatectomy for patients with massive hepatocellular carcinoma (HCC). Methods 64 patients with massive HCC who underwent hepatectomy in Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2014 and January 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the will of patients and their families, these patients were divided into precise group and conventional group. There were 34 cases in precise group, including 28 males and 6 females, with an average age of (54±6) years old. There were 30 cases in conventional group, including 26 males and 4 females, with an average age of(56±7) years old. In precise group, liver volume, tumor location and size and relation with the adjacent vessels were assessed precisely, and surgical protocol was planned and simulated using CT three-dimensional visualization technique before operation. Precise hepatectomy was performed using cavitron ultrasound surgical aspirator (CUSA) or ultrasonic scalpel with the guidance of color Doppler ultrasound. Patients were treated according to the concept of enhanced recovery after surgery after operation. Patients in conventional group received routine CT or MRI before operation, liver resection with clamping method was performed and the porta hepatis was occluded using Pringle maneuver during the operation. Patients received routine nursing and rehabilitation treatments after operation. Intraoperative situation and postoperative liver function of patients between both groups were compared by t test, and the rates were compared by Chi-square test. Results The median length of operation was 229(57-352) min in precise group, significantly more than 138(61-282) min in conventional group (Z=1.752, P<0.05). The postoperative 1 d ALT and AST was respectively 425(24-1 299) and 390(15-1 484) U/L in precise group, significantly lower than574(42-3 533) and 670(76-3 795) U/L in conventional group (Z=-2.099, -2.677; P<0.05). The postoperative length of hospital stay was 6.2(3.0-19.0) d in precise group, significantly less than 9.5(5.0-30.0) d in conventional group (Z=-2.387, P<0.05). Postoperative complications occurred in 3 patients in precise group and 9 patients in conventional group, where significant difference was observed (χ2=4.691, P<0.05). No death case was observed in precise group, while 1 case died of postoperative liver failure in conventional group. Conclusions Compared with conventional liver resection, three-dimensional visualization technique can be used in precise hepatectomy for patients with massive HCC. It has the advantages of less trauma, higher safety and faster postoperative recovery. Key words: Precise hepatectomy; Carcinoma, hepatocellular; Imaging, three-dimensional