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Biosci Trends. 2018;12(5):476-483. doi: 10.5582/bst.2018.01194.

Impact of three-dimensional visualization technology on surgical strategies in complex hepatic cancer.

Zhao D1,2, Lau WY3, Zhou W4, Yang J1,2, Xiang N1,2, Zeng N1,2, Liu J1,2, Zhu W1,2, Fang C1,2.

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Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.
Guangdong Provincial Clinical and Engineering Center of Digital Medicine.
Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories.
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University.


Surgical resection is still the mainstay of treatment for primary liver cancer (PLC). It is unclear whether three-dimensional visualization (3DV) preoperative evaluation and simulated liver resection would affect the surgical strategies and improve the R0 resection rates of patients with complex PLC when compared with the 2D evaluation using computed tomography or magnetic resonance imaging. In the study, patients with complex PLC who were subjected to laparotomy underwent both 2D and 3DV evaluation before operation. A comparison between the 2D and 3DV evaluation was compared with the gold standard of laparotomy findings. In this study, of 335 patients with complex PLC, 71 were assessed to have resectable tumors. 2D and 3DV assessments determined 63 and 71 patients to have resectable PLC, respectively. At laparotomy 69 of the 71 patients were found to have resectable PLC, but 2 patients were found to be unresectable because of detection of metastatic lesions on laparotomy, which were not detected either by 2D or 3DV preoperative evaluation. The accuracy, false positive and false negative rates of the 2D and the 3DV preoperative assessments in determining tumor resectability were 85.9%, 2.8%, 11.3%, and 97.2% (p < 0.05), 2.8%, 0%, respectively. The 3DV and 2D preoperative evaluation revealed 17 and 13 patients with vascular anomalies, respectively. There were 4 patients with major vascular anomalies not detected by 2D evaluation, whose surgical strategies were modified by 3DV evaluation. These results suggested 3DV preoperative assessment could lead to better in evaluating tumor resectability, with potential benefit in the modification of surgical strategy for patients with complex PLC.


Three-dimensional visualization; complex hepatic cancer; surgical strategy; vascular anomaly

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