PURPOSE: The aim of this study was to explore the feasibility of image classification of liver cancer surrounding right hepatic pedicle (RHP) and its guide to precise liver resection. METHODS: Twenty-five patients with single liver cancer surrounding RHP were collected. According to the adjacent relationship between neoplasm and RHP shown in CT or MRI, the liver neoplasms were divided into the 4 types, type A neoplasm infiltrating or surrounding RHP, type B neoplasm locating in the anterior side of RHP, type C neoplasm locating in the dorsal side of RHP and type D neoplasm locating between the two branches. On the basis of image classification, operation project including hepatic vascular occlusion (HVO) and surgical resection procedure was designed. In the end, preoperative classification and surgical design was compared with operative results. RESULTS: The locations of liver neoplasms were completely in line with preoperative classification. The methods of HVO and range of surgical resection were essentially coincident with preoperative plan. Pringle maneuver, total hepatic and hemihepatic vascular occlusion were applied. Four patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy. Seven with type B received right anterior lobectomy or mesohepatectomy. Six with type C underwent segment V, VI resection, and eight with type D received right anterior or posterior lobectomy. All operations were smoothly finished. CONCLUSION: Preoperative classification guided by RHP can provide the accurate location information for liver cancer surrounding RHP, contribute to choosing suitable method of HVO and reasonable range of hepatic resection for precise surgery.
PURPOSE: The aim of this study was to explore the feasibility of image classification of liver cancer surrounding right hepatic pedicle (RHP) and its guide to precise liver resection. METHODS: Twenty-five patients with single liver cancer surrounding RHP were collected. According to the adjacent relationship between neoplasm and RHP shown in CT or MRI, the liver neoplasms were divided into the 4 types, type A neoplasm infiltrating or surrounding RHP, type B neoplasm locating in the anterior side of RHP, type C neoplasm locating in the dorsal side of RHP and type D neoplasm locating between the two branches. On the basis of image classification, operation project including hepatic vascular occlusion (HVO) and surgical resection procedure was designed. In the end, preoperative classification and surgical design was compared with operative results. RESULTS: The locations of liver neoplasms were completely in line with preoperative classification. The methods of HVO and range of surgical resection were essentially coincident with preoperative plan. Pringle maneuver, total hepatic and hemihepatic vascular occlusion were applied. Four patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy. Seven with type B received right anterior lobectomy or mesohepatectomy. Six with type C underwent segment V, VI resection, and eight with type D received right anterior or posterior lobectomy. All operations were smoothly finished. CONCLUSION: Preoperative classification guided by RHP can provide the accurate location information for liver cancer surrounding RHP, contribute to choosing suitable method of HVO and reasonable range of hepatic resection for precise surgery.
Authors: Marcello Donati; Francesco Basile; Gregor A Stavrou; Karl J Oldhafer Journal: J Laparoendosc Adv Surg Tech A Date: 2013-02-14 Impact factor: 1.878