Dynamic surgical anatomy using 3D reconstruction technology in complex hepato-biliary surgery with vascular involvement. Results from an international multicentric survey.

Mauro Alessandro Scotti, Andrea Belli, Renato Patrone, Giuseppe Maria Ettorre, Giammauro Berardi, Fabrizio Di Benedetto, Stefano Di Sandro, Fabrizio Romano, Mattia Garancini, Francesco Izzo, Giorgio Bianchi, Alessandro Germini, Elson Gjoni, Alessandro Bonomi, Federica Bruno, Sissi Paleino, Giacomo Pugliese, Francesca Ratti, Stefano Granieri, Serena Bassetto, Vincenzo Bagnardi, Raffaele Pugliese, Gian Luca Grazi, Alfredo Guglielmi, Andrea Ruzzenente, Luca Aldrighetti, Christian Cotsoglou, Luciano De Carlis, Riccardo De Carlis, Leonardo Centonze, Nicola De Angelis, Riccardo Memeo, Antonella Delvecchio, Emanuele Felli

Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association 2023;26(1):83-90

PMID: 37838501

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Abstract

INTRODUCTION

Three-dimensional liver modeling can lead to substantial changes in choosing the type and extension of liver resection. This study aimed to explore whether 3D reconstruction helps to better understand the relationship between liver tumors and neighboring vascular structures compared to standard 2D CT scan images.

METHODS

Contrast-enhanced CT scan images of 11 patients suffering from primary and secondary hepatic tumors were selected. Twenty-three experienced HBP surgeons participated to the survey. A standardized questionnaire outlining 16 different vascular structures (items) having a potential relationship with the tumor was provided. Intraoperative and histopathological findings were used as the reference standard. The proper hypothesis was that 3D accuracy is greater than 2D. As a secondary endpoint, inter-raters' agreement was explored.

RESULTS

The mean difference between 3D and 2D, was 2.6 points (SE: 0.40; 95 % CI: 1.7-3.5; p < 0.0001). After sensitivity analysis, the results favored 3D visualization as well (mean difference 1.7 points; SE: 0.32; 95 % CI: 1.0-2.5; p = 0.0004). The inter-raters' agreement was moderate for both methods (2D: W = 0.45; 3D: W = 0.44).

CONCLUSION

3D reconstruction may give a significant contribution to better understanding liver vascular anatomy and the precise relationship between the tumor and the neighboring structures.

Address: ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy. Electronic address: [email protected].; ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.; Politecnico di Milano, Scuola di Ingegneria Industriale e Dell'informazione, Via Raffaele Lambruschini, 15, 20156, Milan, Italy.; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca Degli Arcimboldi 8, 20126, Milan, Italy.; AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy.; Hepato-bilio-pancreatic Surgery, Department of Experimental and Clinical Medicine, AOU Careggi, 50134, Florence, Italy.; Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy.; Hepatobiliary Surgery Division, IRCCS San Raffaele and Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.; Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.; Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Ph.D. Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy.; Department of Transplantation, Division of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.; Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France.; Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, 70021 Acquaviva Delle Fonti, Italy.; Service Chirurgie Digestive et Transplantation Hépatique, Hôpital Trousseau CHU, 37170 Tours, France.; Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131, Naples, Italy.; Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131, Naples, Italy; DIETI Department, University of Naples Federico II, 80100, Naples, Italy.; Department of General and Hepatobiliary Surgery, Liver Transplantation Center, San Camillo-Forlanini Hospital, Rome, Italy.; HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy.; General Surgery 1, Hepatobiliary Unit, IRCCS San Gerardo Dei Tintori, University of Milano-Bicocca, 20900, Monza, Italy.; Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP Centre, 75014 Paris, France.; University of Milan, Via Festa Del Perdono, 7, 20122, Milan, Italy.

DOI: 10.1016/j.hpb.2023.10.003