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Purpose: Bilateral hepatolithiasis tends to show recurrent attacks, which may lead to liver damage and bile duct cancer. This study aimed to assess long-term outcome of hepatectomy for bilateral hepatolithiasis based on three-dimensional reconstruction.Method: A total of 258 bilateral hepatolithiasis patients were enrolled in this retrospective study from January 2008 to October 2014. There are 74 individuals in Three-Divisional Visualization System (MI-3DVS) group (group A) and 74 individuals in non-MI-3DVS group (group B) after propensity score matching (PSM), respectively. Then, complication incidence, stone clearance, recurrence, and recurrence-free survival rates were compared between the two groups. Multivariate Cox analysis was used to test impact of MI-3DVS on recurrence-free survival (RFS).Results: The Median (Range) volumes of intraoperative blood loss were 300 (30-1050) and 400 (50-1800) mL in group A and B, respectively (P = .037). Meanwhile, immediate clearance (77% versus 53%, P = .002) and final clearance (95% versus 80%, P = .007) rates were higher in group A compared with values obtained for group B. Multivariate Cox analysis showed non-MI-3DVS (HR = 2.00, 95% confidence interval [CI] = 1.02-3.95, P = .045) and patients with bilateral cirrhosis (Hazard Ratio [HR] = 10.60, 95% CI = 4.45-25.25, P < .001) were independent predictors of RFS.Conclusion: Compared with conventional radiological technology, MI-3DVS-based hepatectomy resulted in higher stone clearance rate of bilateral hepatolithiasis patients. Non-MI-3DVS and patients with bilateral cirrhosis were independent predictors for recurrence-free survival. [ABSTRACT FROM AUTHOR]

Background: Hepatolithiasis is a complex condition that poses challenges and difficulties in surgical treatment. Three‐dimensional visualization technology combined with fluorescence imaging (3DVT‐FI) enables accurate preoperative assessment and real‐time intraoperative navigation. However, the perioperative outcomes of 3DVT‐FI in hepatolithiasis have not been reported. We aim to evaluate the efficacy of 3DVT‐FI in the treatment of hepatolithiasis. Methods: A retrospective analysis was performed on 128 patients who underwent hepatectomy for hepatolithiasis at the Department of Hepatobiliary Surgery, Zhujiang Hospital, between January 2017 and December 2022. Among them, 50 patients underwent hepatectomy using 3DVT‐FI (3DVT‐FI group), while 78 patients underwent conventional hepatectomy without 3DVT‐FI (CH group). The operative data, postoperative liver function indices, complication rates and stone residue were compared between the two groups. Results: There were no significant differences in preoperative baseline data between the two groups (p > 0.05). Compared with the CH group, the 3DVT‐FI group exhibited lower intraoperative blood loss (140.00 ± 112.12 vs. 225.99 ± 186.50 mL, p = 0.001), and a lower intraoperative transfusion rate (8.0% vs. 23.1%, p = 0.027). The overall incidence of postoperative complications did not differ significantly (22.0% vs. 35.9%, p = 0.096). The 3DVT‐FI group was associated with a lower immediate residual stone rate (16.0% vs. 34.6%, p = 0.021). There were no perioperative deaths in the 3DVT‐FI group, while one perioperative death occurred in the CH group. Conclusions: The 3DVT‐FI may offer significant benefits in terms of surgical safety, reduced intraoperative bleeding and decreased stone residue during hepatectomy for hepatolithiasis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic hepatectomy for centrally located hepatocellular carcinoma is challenging to perform. Augmented reality navigation (ARN) and fluorescence imaging are currently safe and reproducible techniques for hepatectomy, but the efficacy results for centrally located hepatocellular carcinoma have not been reported. This study aimed to evaluate the efficacy of an ARN system combined with fluorescence imaging (ARN-FI) in laparoscopic hepatectomy for centrally located hepatocellular carcinoma. STUDY DESIGN: This was a post hoc analysis of an original nonrandomized clinical trial that was designed to evaluate the feasibility and efficacy of ARN-FI for laparoscopic liver resection. A total of 76 patients were consecutively enrolled from June 2018 to June 2021, of which 42 underwent laparoscopic hepatectomy using ARN-FI (ARN-FI group), and the other 34 who did not use ARN-FI guidance (non–ARN-FI group). Perioperative outcomes and disease-free survival were compared between the 2 groups. RESULTS: Compared with the non–ARN-FI group, the ARN-FI group had less intraoperative blood loss (median 275 vs 300 mL, p = 0.013), lower intraoperative transfusion rate (14.3% vs 64.7%, p < 0.01), shorter postoperative hospital stay (median 8 vs 9 days, p = 0.005), and lower postoperative complication rate (35.7% vs 61.8%, p = 0.024). There was no death in the perioperative period and follow-up period. There was no significant difference in overall disease-free survival between the 2 groups (p = 0.16). CONCLUSIONs: The ARN system and fluorescence imaging may be of value in improving the success rate of surgery, reducing postoperative complications, accelerating postoperative recovery, and shortening postoperative hospital stay. This study found that augmented reality navigation and fluorescence imaging showed favorable results in the perioperative period. In addition, although no significant differences in disease-free survival (DFS) were found between the 2 groups overall, the cohort with both techniques showed higher DFS in subgroup analysis of type IV centrally located hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

BACKGROUND: The augmented reality-assisted navigation system (AR-ANS) has been initially applied to the management of hepatolithiasis. The current study examines the safety and efficacy of the AR-ANS for hepatectomy in the treatment of hepatolithiasis. It is the first study to assess the preoperative and long-term outcomes of hepatectomy guided by the AR-ANS for hepatolithiasis. STUDY DESIGN: From January 2018 to December 2021, 77 patients with hepatolithiasis who underwent hepatectomy at Zhujiang Hospital of Southern Medical University were included. The subjects were divided into the AR group (n = 31) and the non-AR group (n = 46) according to whether the surgery was guided by the AR-ANS. Clinical baseline features, operation time, intraoperative blood loss, immediate postoperative residual stone rate, postoperative stone recurrence rate at 6 months, and postoperative complications were analyzed. RESULTS: There was no significant difference between preoperative baseline data from the 2 groups (p > 0.05). The AR group had a longer surgical time than the non-AR group (p < 0.001). The intraoperative blood loss in the AR group was lower than in the non-AR group (p < 0.001). Alanine transaminase, aminotransferase, immediate residual stone rate, and stone recurrence rate in the AR group were lower than in the non-AR group (p < 0.05). There was no significant difference in postoperative complications between the 2 groups. CONCLUSIONS: The application of the AR-ANS in hepatectomy for hepatolithiasis has not only achieved satisfactory therapeutic efficacy, but has also shown significant advantages in reducing intraoperative blood loss, immediate stone residual rate, and stone recurrence rate, which has clinical promotion value. [ABSTRACT FROM AUTHOR]

Background: With the improvement in diagnostic imaging, perioperative care and surgical technique, the indications and complexity of liver resections have developed. However, the surgical indications remain controversial especially for some complex or advanced hepatocellular carcinomas. This study was designed to evaluate the concordance between hepatectomy recommendations proposed by Watson for Oncology, a cognitive technology providing decision support, and those determined by surgeons in our center for patients with hepatocellular carcinoma. Methods: We retrospectively reviewed 243 patients with hepatocellular carcinoma who were recommended for surgical treatment and received hepatectomy between 2008 and 2016 at the Zhujiang Hospital of Southern Medical University. Watson for Oncology classified the treatment options into three categories: recommended, for consideration and not recommended. Treatment recommendations were considered concordant if the hepatectomy recommendations were designated "recommended" or "for consideration" by Watson for Oncology. The factors potentially affecting concordance rate were also analyzed in our study. Results: The hepatectomy recommendations of 174 patients were concordant. There were significant differences in the coincidence rate between concordant group and discordant group considering tumor numbers (P = 0.006), extension of hepatectomy (P = 0.009) and BCLC staging system (P < 0.001). Lower degrees of concordance were observed in patients with multiple tumors, major hepatectomy and portal hypertension by using logistic regression analysis (OR = 0.309, P = 0.004; OR = 0.384, P = 0.004; and OR = 0.376, P = 0.022, respectively). Conclusion: The concordance between Watson for Oncology and surgeons' hepatectomy recommendation for hepatocellular carcinoma was only 72%. Differences in practice patterns for HCC between the USA (where Watson for Oncology was calibrated) and China may be the major cause of discordance. Watson for Oncology still requires further improvement and localization to be widely applied in China. [ABSTRACT FROM AUTHOR]

Background: Hepatectomy is the optimal method for liver cancer; the virtual liver resection based on three-dimensional visualization technology (3-DVT) could provide better preoperative strategy for surgeon. We aim to introduce right posterior lobe allied with part of V and VIII sectionectomy assisted by 3-DVT as a promising treatment for massive or multiple right hepatic malignancies to retain maximum residual liver volume on the basis of R0 resection.Methods: Among 126 consecutive patients who underwent hepatectomy, 9 (7%) underwent right posterior lobe allied with part of V and VIII sectionectomy. 21 (17%) underwent right hemihepatectomy (RH). The virtual RH was performed with 3-DVT, which provided better observation of spatial position relationship between tumor and vessels, and the more accurate estimation of the remnant liver volume. If remnant liver volume was <40%, right posterior lobe allied with part of V and VIII sectionectomy should be undergone. Then, the precut line ought to be planned on the basis of protecting the portal branch of subsegment 5 and 8. The postoperative outcome of patients was compared before and after propensity score matching.Results: Nine patients meeting the eligibility criteria received right posterior lobe allied with part of V and VIII sectionectomy. The variables, including the overall mean operation time, blood transfusion, operation length, liver function, and postoperative complications, were similar between two groups before and after propensity matching. The postoperative first, third, fifth, and seventh days mean value of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), and total bilirubin had no significant difference compared with preoperative value. One patient in each group had recurrence six months after surgery.Conclusion: Right posterior lobe allied with part of V and VIII sectionectomy based on 3-DVT is safe and feasible surgery way, and can be a very promising method in massive or multiple right hepatic malignancy therapy. [ABSTRACT FROM AUTHOR]