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Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2016 | Research

Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type III hilar cholangiocarcinoma

Authors: Ning Zeng, Haisu Tao, Chihua Fang, Yingfang Fan, Nan Xiang, Jian Yang, Wen Zhu, Jun Liu, Tianpei Guan, Cheng Fang, Fei Xiang

Published in: World Journal of Surgical Oncology | Issue 1/2016

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Abstract

Background

A detailed evaluation of blood supply anatomy, especially the biliary anatomy at the hepatic hilus, is essential to ensure a complete and curative resection for Bismuth and Corlette type III hilar cholangiocarcinoma. The study aimed to investigate the impact of individualized preoperative planning using 3D modeling on surgical treatment for type III hilar cholangiocarcinoma.

Methods

This was a retrospective study of patients with type III hilar cholangiocarcinoma (n = 47) who underwent surgery at the Hepatobiliary Surgery Department of Zhujiang Hospital between March 2007 and January 2015. All patients had undergone preoperative computed tomography (CT) examination, and 3D images were reconstructed. Preoperative surgery simulation was performed, and the simulation was applied in the subsequent surgery. Clinical, surgical, and pathological characteristics were compared between patients undergoing preoperative planning (n = 25) and those who did not (n = 22). Complications were examined.

Results

Surgical time and blood loss were significantly smaller in patients with 3D reconstruction compared to those without. The number of bile duct orifices was correctly estimated in 14/25 (56.0 %) patients with preoperative planning. The width of the hepatic surgical margin could be measured for 18 hepatic ducts, and 17 (68.0 %) of them were pathologically diagnosed as margin-negative.

Conclusions

This technique has the advantages of precise visualization of the anatomic structures and 3D assessment of biliary branches and vessels, allowing improved operative planning for the treatment of hilar cholangiocarcinoma.
Literature
1.
go back to reference NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Hepatobiliary cancers. version 2.2015. Fort Washington: National Comprehensive Cancer Network; 2015. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Hepatobiliary cancers. version 2.2015. Fort Washington: National Comprehensive Cancer Network; 2015.
3.
go back to reference Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefPubMed Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.CrossRefPubMed
4.
go back to reference Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol. 2005;31:533–9.CrossRefPubMed Silva MA, Tekin K, Aytekin F, Bramhall SR, Buckels JA, Mirza DF. Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK. Eur J Surg Oncol. 2005;31:533–9.CrossRefPubMed
5.
go back to reference Iwatsuki S, Todo S, Marsh JW, Madariaga JR, Lee RG, Dvorchik I, et al. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg. 1998;187:358–64.PubMedCentralCrossRefPubMed Iwatsuki S, Todo S, Marsh JW, Madariaga JR, Lee RG, Dvorchik I, et al. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg. 1998;187:358–64.PubMedCentralCrossRefPubMed
6.
go back to reference Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.CrossRefPubMed Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.CrossRefPubMed
7.
8.
go back to reference Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, et al. Complications of hepatectomy for hilar cholangiocarcinoma. World J Surg. 2001;25:1277–83.CrossRefPubMed Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, et al. Complications of hepatectomy for hilar cholangiocarcinoma. World J Surg. 2001;25:1277–83.CrossRefPubMed
9.
go back to reference Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.PubMedCentralCrossRefPubMed Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.PubMedCentralCrossRefPubMed
10.
go back to reference Hirano S, Tanaka E, Shichinohe T, Suzuki O, Hazama K, Kitagami H, et al. Treatment strategy for hilar cholangiocarcinoma, with special reference to the limits of ductal resection in right-sided hepatectomies. J Hepatobiliary Pancreat Surg. 2007;14:429–33.CrossRefPubMed Hirano S, Tanaka E, Shichinohe T, Suzuki O, Hazama K, Kitagami H, et al. Treatment strategy for hilar cholangiocarcinoma, with special reference to the limits of ductal resection in right-sided hepatectomies. J Hepatobiliary Pancreat Surg. 2007;14:429–33.CrossRefPubMed
11.
go back to reference Shimizu H, Sawada S, Kimura F, Yoshidome H, Ohtsuka M, Kato A, et al. Clinical significance of biliary vascular anatomy of the right liver for hilar cholangiocarcinoma applied to left hemihepatectomy. Ann Surg. 2009;249:435–9.CrossRefPubMed Shimizu H, Sawada S, Kimura F, Yoshidome H, Ohtsuka M, Kato A, et al. Clinical significance of biliary vascular anatomy of the right liver for hilar cholangiocarcinoma applied to left hemihepatectomy. Ann Surg. 2009;249:435–9.CrossRefPubMed
12.
go back to reference Uchida M, Ishibashi M, Tomita N, Shinagawa M, Hayabuchi N, Okuda K. Hilar and suprapancreatic cholangiocarcinoma: value of 3D angiography and multiphase fusion images using MDCT. AJR Am J Roentgenol. 2005;184:1572–7.CrossRefPubMed Uchida M, Ishibashi M, Tomita N, Shinagawa M, Hayabuchi N, Okuda K. Hilar and suprapancreatic cholangiocarcinoma: value of 3D angiography and multiphase fusion images using MDCT. AJR Am J Roentgenol. 2005;184:1572–7.CrossRefPubMed
13.
go back to reference Kim HJ, Kim AY, Hong SS, Kim MH, Byun JH, Won HJ, et al. Biliary ductal evaluation of hilar cholangiocarcinoma: three-dimensional direct multi-detector row CT cholangiographic findings versus surgical and pathologic results—feasibility study. Radiology. 2006;238:300–8.CrossRefPubMed Kim HJ, Kim AY, Hong SS, Kim MH, Byun JH, Won HJ, et al. Biliary ductal evaluation of hilar cholangiocarcinoma: three-dimensional direct multi-detector row CT cholangiographic findings versus surgical and pathologic results—feasibility study. Radiology. 2006;238:300–8.CrossRefPubMed
14.
go back to reference Endo I, Shimada H, Sugita M, Fujii Y, Morioka D, Takeda K, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007;142:666–75.CrossRefPubMed Endo I, Shimada H, Sugita M, Fujii Y, Morioka D, Takeda K, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma. Surgery. 2007;142:666–75.CrossRefPubMed
15.
go back to reference Gavrilovici V, Grecu F, Seripcariu V, Dragomir C. [Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors): clinical application and practical relevance]. Rev Med Chir Soc Med Nat Iasi. 2011;115:412–7.PubMed Gavrilovici V, Grecu F, Seripcariu V, Dragomir C. [Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors): clinical application and practical relevance]. Rev Med Chir Soc Med Nat Iasi. 2011;115:412–7.PubMed
16.
go back to reference Baton O, Azoulay D, Adam DV, Castaing D. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes. J Am Coll Surg. 2007;204:250–60.CrossRefPubMed Baton O, Azoulay D, Adam DV, Castaing D. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes. J Am Coll Surg. 2007;204:250–60.CrossRefPubMed
17.
go back to reference Lim JH, Choi GH, Choi SH, Kim KS, Choi JS, Lee WJ. Liver resection for Bismuth type I and Type II hilar cholangiocarcinoma. World J Surg. 2013;37:829–37.CrossRefPubMed Lim JH, Choi GH, Choi SH, Kim KS, Choi JS, Lee WJ. Liver resection for Bismuth type I and Type II hilar cholangiocarcinoma. World J Surg. 2013;37:829–37.CrossRefPubMed
18.
go back to reference Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, Perez-Daga JA, Garcia-Albiach B, Pulido-Roa Y, et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5:132–8.PubMedCentralCrossRefPubMed Suarez-Munoz MA, Fernandez-Aguilar JL, Sanchez-Perez B, Perez-Daga JA, Garcia-Albiach B, Pulido-Roa Y, et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5:132–8.PubMedCentralCrossRefPubMed
19.
go back to reference Izbicki JR, Tsui TY, Bohn BA, Bockhorn M. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor). J Gastrointest Surg. 2013;17:581–5.CrossRefPubMed Izbicki JR, Tsui TY, Bohn BA, Bockhorn M. Surgical strategies in patients with advanced hilar cholangiocarcinoma (Klatskin tumor). J Gastrointest Surg. 2013;17:581–5.CrossRefPubMed
20.
go back to reference Peng FP, Bao SS. Segmentation of liver and its ducts in CT image sequences. Computer Engineering and Applications. 2009;20:205–7. Peng FP, Bao SS. Segmentation of liver and its ducts in CT image sequences. Computer Engineering and Applications. 2009;20:205–7.
21.
go back to reference Peng FP, Bao SS, Zeng BQ. Virtual hepatobiliary surgery based on 64-slice CT data. Journal of System Simulation. 2009;21:5458–61. Peng FP, Bao SS, Zeng BQ. Virtual hepatobiliary surgery based on 64-slice CT data. Journal of System Simulation. 2009;21:5458–61.
22.
go back to reference Yang J, Fang CH, Fan YF, Xiang N, Liu J, Zhu W, et al. To assess the benefits of medical image three-dimensional visualization system assisted pancreaticoduodenctomy for patients with hepatic artery variance. Int J Med Robot. 2014;10:410–7.CrossRefPubMed Yang J, Fang CH, Fan YF, Xiang N, Liu J, Zhu W, et al. To assess the benefits of medical image three-dimensional visualization system assisted pancreaticoduodenctomy for patients with hepatic artery variance. Int J Med Robot. 2014;10:410–7.CrossRefPubMed
23.
go back to reference Fang CH, Liu J, Fan YF, Yang J, Xiang N, Zeng N. Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique. J Am Coll Surg. 2013;217:280–8.CrossRefPubMed Fang CH, Liu J, Fan YF, Yang J, Xiang N, Zeng N. Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique. J Am Coll Surg. 2013;217:280–8.CrossRefPubMed
Metadata
Title
Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type III hilar cholangiocarcinoma
Authors
Ning Zeng
Haisu Tao
Chihua Fang
Yingfang Fan
Nan Xiang
Jian Yang
Wen Zhu
Jun Liu
Tianpei Guan
Cheng Fang
Fei Xiang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-0794-8

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