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Paradigm shift: should preoperative 3D reconstruction models become mandatory before hepatectomy for hepatocellular carcinoma (HCC)? Results of a multicenter prospective trial

Published:November 16, 2022DOI:https://doi.org/10.1016/j.hpb.2022.11.007

      Abstract

      Background

      A preoperative surgical strategy before hepatectomy for hepatocellular carcinoma is fundamental to minimize postoperative morbidity and mortality and to reach the best oncologic outcomes. Preoperative 3D reconstruction models may help to better choose the type of procedure to perform and possibly change the initially established plan based on conventional 2D imaging.

      Methods

      A non-randomized multicenter prospective trial with 136 patients presenting with a resectable hepatocellular carcinoma who underwent open or minimally invasive liver resection. Measurement was based on the modification rate analysis between conventional 2D imaging (named “Plan A”) and 3D model analysis (“Plan B”), and from Plan B to the final procedure performed (named “Plan C”).

      Results

      The modification rate from Plan B to Plan C (18%) was less frequent than the modification from Plan A to Plan B (35%) (OR = 0.32 [0.15; 0.64]). Concerning secondary objectives, resection margins were underestimated in Plan B as compared to Plan C (−3.10 mm [−5.04; −1.15]).

      Conclusion

      The present study suggests that preoperative 3D imaging of the liver is associated with a better prediction of the performed surgical procedure for liver resection in HCC, as compared to classical 2D imaging.
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