Effect of laparoscopic anatomical hepatectomy for hepatocellular carcinoma based on individualized three-dimensional reconstruction model of portal vein region.

backgroundHepatocellular carcinoma (HCC) accounts for 90% of primary liver tumors. With the development of laparoscopic technology, laparoscopic liver resection is safer and more effective compared to traditional open surgery. However, HCC tumors are often located near major blood vessels and bile ducts, which increases the difficulty of precise resection. To address these challenges, computer-based three-dimensional (3D) liver reconstruction technology has been widely applied. This technology converts two-dimensional imaging data into detailed three-dimensional anatomical models, clearly displaying the vascular anatomy within the liver, accurately locating the lesion, defining the surgical margin, and estimating the liver volume. Its intuitive and multi-angle visualization enhances surgical understanding and decision-making, providing crucial support for preoperative assessment, surgical planning, and intraoperative navigation.Three-dimensional watershed analysis based on hepatic veins and hepatic pedicles is one of the two major strategies for guiding anatomical liver resection. However, the existing articles lack a comparison between different methods. Therefore, we conducted a comparative study of two different resection methods for hepatocellular carcinoma (HCC) to determine their advantages in terms of clinical outcomes.

methodsPatients diagnosed with hepatocellular carcinoma and treated with laparoscopic hepatectomy at Shenzhen People’s Hospital from 2018 to 2021 were the subjects of a retrospective study of clinical data. Two separate groups of participants, one with venous access and the other with hepatic pedicle access, were evaluated at the same time. Data was collected during the operation, immediately after the procedure, and at 36 months to compare the two surgical approaches.

resultsNo statistically significant difference in preoperative data was found between the two groups in this study, which included 78 patients. With a p-value of only 0.033, the hepatic pedicle group lost 50 ml less blood than the vein group. In comparison to the hepatic vein group, the hepatic pedicle group had substantially lower levels of ALT (P = 0.022), AST (P = 0.036), and postoperative complication rate (P = 0.031). The hepatic pedicle group showed a 78.4% survival rate and a 56.1% tumor-free rate, whereas the hepatic vein group demonstrated a 70.7% overall survival rate and a 36.6% tumor-free survival rate. Tumor-free survival was significantly longer in the hepatic pedicle group (P = 0.040), while overall survival did not differ significantly between the two groups. (P > 0.05).

conclusionsThree-dimensional (3D) reconstruction-guided hepatic pedicle laparoscopic anatomical hepatectomy was safe and effective and demonstrated favorable perioperative and oncologic outcomes, revealing the clinical value of 3D visualization in anatomical liver resection.