Abstract
BACKGROUND: With the advancement of precise hepatic resection and three-dimensional (3D) reconstruction technology, there is a growing emphasis on precision in liver surgery. However, during hepatic resection, thick hepatic veins may appear in the portal vein basin, and injury to thick hepatic veins may cause residual hepatic stasis, resulting in impaired liver function, or even failure. Therefore, we developed a new computer-assisted hepatic surgical planning system that integrates the portal and hepatic vein basins. This system is designed to achieve oncological safety and preserve functional hepatic tissues by reducing ischemic volume (IV), congested volume (CV), and transection surface area (TSA), leaving the residual liver with less ischemic volume, sludge volume, and cross-sectional area, thereby optimizing postoperative outcomes. METHODS: Contrast-enhanced computed tomography (CT) datasets from 20 patients at The First Affiliated Hospital of Ningbo University were analyzed for 3D reconstruction. Using a pseudorandom number generator algorithm, 140 liver occupancy models were established with seven points selected from each case. Three distinct surgical simulation strategies were compared: hepatic-portal venous territory integration, anatomical portal territory resection, and non-anatomical resection (NAR) (1-cm margin), the liver occupancy models were compared with the three types of surgical planning. Quantitative parameters, including Resected Index (RI, resected volume/total liver volume), Ischemic Index (II, residual ischemic volume/total liver volume), Congestion Index (CI, residual CV/total liver volume), and transection surface ratio (TSR, cross-sectional area/total liver surface area), were analyzed to evaluate the value of the surgical planning system. RESULTS: Compared with portal vein basin anatomical hepatectomy, the integrated method had smaller RI [8.09 (3.00, 20.12) vs. 18.9 (2.84, 42.29), P<0.05], CI [1.14 (0.37, 3.68) vs. 3.39 (0.35, 13.26), P<0.05], II [2.28 (0.82, 7.10) vs. 3.39 (0.35, 13.26), P<0.05], and TSR [14,417.13 (7,462.02, 32,715.68) vs. 73,739.52 (47,559.78, 102,632.74), P<0.05]. When compared to NAR, the integration strategy achieved reduced II [1.15 (0.46, 3.43) vs. 7.63 (3.00, 24.16), P<0.05], CI [1.14 (0.37, 3.68) vs. 7.67 (2.16, 22.98), P<0.05], and RI [2.28 (0.82, 7.10) vs. 15.28 (4.46, 47.14), P<0.05]. CONCLUSIONS: In this study, we established a surgical planning system coordinating portal perfusion territories with hepatic venous drainage basins. The computational planning system significantly improves surgical precision by reducing residual ischemic volume, venous congestion, and parenchymal transection area.