Usefulness of three-dimensional(3D) simulation software in hepatectomy for pediatric hepatoblastoma.

BACKGROUND: Hepatoblastoma (HB) is the most common malignant liver tumor in childhood. Complete HB surgical resection which is technically demanding is the cornerstone of effective therapy with a good prognosis. The aim of our study is to evaluate the usefulness of 3D simulation software in assisting hepatectomy in pediatric patients with HB.

METHODS: 21 children with HB who underwent hepatectomy were enrolled in this study. All patients underwent computer tomography (CT) imaging preoperatively. CT images from 11 cases (from September 2013 to August 2015) were reconstructed with Hisense CAS, and performed hetpatectomy. While 10 cases (from September 2011 to August 2013) without 3D simulation were token as the control group. The clinical outcome were analyzed and compared between the 2 groups.

RESULTS: All the HB were successfully removed for all patients and there was no positive margins in the surgical specimens, no complications, and no recurrences. For the reconstructing group, 3D simulation software successfully reconstructed the 3D images of liver and were used as a navigator in the operation room during hepatectomy. Anatomic hepatectomy were successfully completed for all patients after operation planning using the software. There was no obvious discrepancy between the virtual and the actual hepatectomy. The mean operation time was shorter (142.18 ± 21.87 min VS. the control group, 173.5 ± 54.88 min, p = 0.047) and intraoperative bleeding was less (28.73 ± 14.17 ml VS. 42.8 ± 41.12 ml, p = 0.011) in the reconstructing group. Moreover, postoperative hospital stay tended to be shorter in the reconstructing group (11.18 ± 2.78d VS. the control group 13 ± 3.46d, P = 0.257).

CONCLUSIONS: 3D simulation software facilitates the investigation of the complex liver structure, contributes to the optimal operation planning, and enables an individualized anatomic hepatectomy for each pediatric patient with HB.