Prediction of remnant liver volume using 3D simulation software in patients undergoing R1vasc parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases: reliability, clinical impact, and learning curve. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Procopio, Fabio; Cimino, Matteo; Viganò, Luca; Colombo, Anna E.; Franchi, Eloisa; Costa, Guido; Donadon, Matteo; Del Fabbro, Daniele; Torzilli, Guido
• Is Part Of: HPB. Volume 23:Issue 7(2021)
• Page Start: 1084
• Page End: 1094
• Publication Date: 2021-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2020.11.005
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Assessment of the future liver remnant (FLR) is routinely performed before major hepatectomy. In R1-vascular one-stage hepatectomy (R1vasc-OSH), given the multiplanar dissection paths, the FLR is not easily predictable. Preoperative 3D-virtual casts may help. We evaluated the predictability of the FLR using the 3D-virtual cast in the R1vasc-OSH for multiple bilobar colorectal liver metastases (CLM). Methods: Thirty consecutive patients with multiple bilobar CLMs scheduled for R1vasc-OSH were included. Predicted and real-FLRs were compared. Propensity score-matched analysis was used to determine the impact of 3D-virtual cast on postoperative complications. Results: Median number of CLM and resection areas were 12 (4–33) and 3 (1–8). Median predicted-FLR was 899 ml (558–1157) and 60% (42–85), while for the real-FLR 915 ml (566–1777) and 63% (43–87). Median discrepancy between predicted and real-FLR was −0.6% (p = 0.504), indicating a slight tendency to underestimate the FLR. The difference was more evident in more than 12 CLMs (p = 0.013). A discrepancy was not evident according to the number of resection areas (p = 0.316). No mortality occurred. Patients in virtual-group had lower major complications compared to nonvirtual-group (0% vs 18%, p-value 0.014). Conclusion: FLR estimation based on 3D-analysis is feasible, provides a safe surgery and represents a promising method in planning R1vasc-OSH for patients with multiple bilobar CLMs.