Abstract
Background
Hepatectomy is particularly difficult when the tumor is large, close to the inferior vena cava or the main trunk of the hepatic or portal vein, or in the caudate lobe, as well as when the operation is a re-hepatectomy, because two-dimensional computed tomography (CT) often does not clearly show tumor location relative to blood vessels.
Study Design
To evaluate the efficacy of three-dimensional computed tomography (3D-CT), reconstructed from multidetector-row computed tomography (MD-CT) with contrast, MD-CT was performed in 17 patients before hepatectomy.
Results
The third-order branches of the hepatic artery and the portal vein were clearly shown in all cases. Both the hepatic vein, which drained the same segment that the portal vein fed, and the portal vein were also clearly shown. These vessels could be visualized from any perspective. In 2 patients who underwent hemihepatectomy, large tumors (23.0 and 17.0 cm) displaced the vasculature, but the positions of tumor and vessels could be precisely evaluated by 3D-CT. In patients who required replacement of the vena cava with synthetic grafts, the distance and direction of pressure to IVC by tumor was accurately estimated by 3D-CT. In patients who were limited to segmentectomy or partial hepatectomy because of prior hepatectomy or tumor position, evaluation of the glissons was facilitated by 3D-CT.
Conclusions
Three-dimensional-CT was extremely useful for preoperative simulation because it provided important information that could not be obtained with 2D-CT.
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References
Umeshita K, Fujiwara K, Kiyosawa K, et al. Operative morbidity of living liver donors in Japan. Japanese Liver Transplantation Society. Lancet 2003;362:687–690
Sarmiento JM, Que FG, Nagorney DM. Surgical outcomes of isolated caudate lobe resection: a single series of 19 patients. Surgery 2002;132:697–708
Taschieri AM, Elli M, Vignati GA, et al. Repeated liver resection for recurrent metastases from colorectal cancer. Hepatogastroenterology 2003;50:472–474
Kalender WA, Seissler W, Klotz E, et al. Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology 1990;176:181–183
Hu H, He HD, Foleyet WD, et al. Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 2000;215:55–62
Onodera Y, Omatsu T, Nakayama J, et al. Peripheral anatomic evaluation Using 3D CT hepatic venography in donors: significance of peripheral venous visualization in living-donor liver transplantation. AJR Am J Roentgenol 2004;183:1065–1070
Couinaud C. Lobes et segments hepatiques: notes sur l’architecture anatomique et chirurgicale de foie. Presse Med 1954;62:709–712
Healey JE, Schroy PC. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branching and the major variations of the biliary ducts. Arch Surg 1953;66:599–616
Takayasu K, Moriyama N, Muramatsu Y, et al. Intrahepatic portal vein branches studied by percutaneous transhepatic portography. Radiology 1985;154:31–36
Fishman EK, Magid D, Ney DR, et al. Three-dimensional imaging. Radiology 1991;181:321–337
Lee SW, Shinohara H, Matsuki M, et al. Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 2003;197:927–936
Iwatsuki S, Todo S, Starzl E. Right trisegmentectomy with a synthetic vena cava graft. Arch Surg 1988;123:1021–1022
Minagawa M, Makuuchi M, Takayama T, et al. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003;238:703–710
Imamura H, Matsuyama Y, Miyagawa Y, et al. Prognostic significance of anatomical resection and des-gamma-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg 1999;86:1032–1038
Abdalla EK, Vauthey JN, Couinaud C. The caudate lobe of the liver: implications of embryology and anatomy for surgery. Surg Oncol Clin North Am 2002;11:835–848
Takayama T, Makuuchi M. Segmental liver resections, present and future-caudate lobe resection for liver tumors. Hepatogastroenterology 1998;45:20–23
Peng SY, Li JT, Mou YP, et al. Different approaches to caudate lobectomy with “curettage and aspiration” technique using a special instrument PMOD: a report of 76 cases. World J Gastroenterol 2003;9:2169–2173
Takayama T, Tanaka T, Higaki T, et al. High dorsal resection of the liver. J Am Coll Surg 1994;179:72–75
Acknowledgements
The authors thank Minoru Ohta and the staff of General Surgery, Graduate School of Medicine, Hokkaido University, for their kind cooperation.
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Kamiyama, T., Nakagawa, T., Nakanishi, K. et al. Preoperative Evaluation of Hepatic Vasculature by Three-Dimensional Computed Tomographyin Patients Undergoing Hepatectomy. World J. Surg. 30, 400–409 (2006). https://doi.org/10.1007/s00268-005-0383-4
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DOI: https://doi.org/10.1007/s00268-005-0383-4