Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ann Surg. 2018 Jul;268(1):127-133. doi: 10.1097/SLA.0000000000002213.
To assess how virtual hepatectomy (VH), conducted using surgical planning software, influences the outcomes of liver surgery.
Imaging technology visualizes the territories of the liver vessels, which were previously impossible. However, the clinical impact of VH has not been evaluated.
From 2004 to 2013, we performed 1194 VHs preoperatively. Outcomes of living donor liver transplantation (LDLT) and hepatectomy for hepatocellular carcinoma (HCC)/colorectal liver metastases (CRLM) were compared between patients in whom VH was performed (VH) and those without VH evaluation (non-VH).
In LDLT, the rate of right liver graft use was higher in the VH (62.1%) than in the non-VH (46.5%) (P < 0.01), which did not increase morbidity of donor surgery. Duration of recipient surgery in the VH in which middle hepatic vein branch reconstruction was skipped was shorter than that in the VH with venous reconstruction. Among HCC patients with impaired liver function, portal territory-oriented resection was conducted more often in the VH than in the non-VH. The 5-year disease-free survival rate for localized HCC was higher in the VH than in the non-VH (37.2% vs 23.9%; P = 0.04). In CRLM, long-term outcomes were similar in the VH and non-VH despite the larger tumor load in the VH.
VH in LDLT allows double equipoise for the recipient and donor by optimizing decision-making on graft selection and venous reconstruction. VH offers a chance for radical hepatectomy even in HCC patients with impaired liver function and CRLM patients with advanced tumors, without compromising survival.
评估使用手术规划软件进行虚拟肝切除术（VH）对肝切除术结果的影响。
成像技术可使肝血管的区域可视化，这在以前是不可能的。然而，VH 的临床影响尚未得到评估。
2004 年至 2013 年，我们术前共进行了 1194 例 VH。将接受 VH 与未行 VH 评估的患者（非 VH）的活体供肝移植（LDLT）和肝细胞癌（HCC）/结直肠癌肝转移（CRLM）肝切除术的结果进行比较。
在 LDLT 中，VH 组右半肝供肝使用率（62.1%）高于非 VH 组（46.5%）（P < 0.01），但并未增加供者手术的发病率。VH 中跳过中肝静脉分支重建时受体手术的持续时间比有静脉重建的 VH 短。在肝功能受损的 HCC 患者中，VH 中更常进行门脉区域导向性肝切除术。VH 组局限性 HCC 的 5 年无疾病生存率高于非 VH 组（37.2%比 23.9%；P = 0.04）。在 CRLM 中，尽管 VH 组的肿瘤负荷较大，但 VH 和非 VH 组的长期结果相似。
在 LDLT 中，VH 通过优化供肝选择和静脉重建的决策，为受体和供体提供双重平衡。VH 为肝功能受损的 HCC 患者和晚期肿瘤的 CRLM 患者提供了根治性肝切除术的机会，而不会影响生存率。
