3D Imaging Reconstruction Can Recognize Functional Tissue and Predict Liver Failure.

Abstract Background: The aim of this study is to evaluate the future liver remnant after major hepatectomy with 3D modelling treated, respectively, with associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE). Methods: Patients submitted to ALPPS at our centre were compared with a group of patents submitted to the PVE followed by major hepatectomy. 3D reconstruction was realised before and after surgical treatment, and anatomic future liver remnant (FRL) and functional future liver remnant (FRFx) were calculated and compared with clinical outcomes. Results: From May 2011 to October 2019, 11 ALPPS procedures were realised at Sanchinarro University Hospital, Madrid. They were compared to a control group composed of 13 patients who underwent PVE followed by hepatectomy. The increase of anatomical FRL (iFRL) was superior in the ALPPS group (120%) with respect to the PVE group (73%) (p=0,041), while the increase of functional FRFX (iFRFx) was 35% in the ALLPS group and 46% in the PVE group (p>0,05), showing no difference in the two groups. PHLF grade B and C occurred in 6 patients. The ROC curve showed a better AUC for FRFxVpost (74%) with respect to FRLVpost (54%) in prediction PHLF>B. Conclusion: The 3D reconstruction model can allow optimal surgical planning, and through the use of specific algorithms, can contribute to differential functioning liver parenchyma of the FLR.