Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature

Figure 1 The proximity of the tumor to the major liver vasculature in children with hepatoblastoma who received a full course of neoadjuvant chemotherapy. A and E: The distance from the tumor to the inferior vena cava was within 1 cm (V0); B and F: The tumor was touching the inferior vena cava (V1); C and G: The tumor was compressing all intrahepatic veins (V2+P2); D and H: Presence of a tumor thrombus and cavernous transformation of the portal vein (P3).

Figure 2 A case of giant hepatoblastoma in the middle lobe of the liver. A: The tumor was initially discovered to be giant, causing distortion and displacement of all the intrahepatic blood vessels. A needle biopsy confirmed the presence of a hepatoblastoma, and neoadjuvant chemotherapy was recommended as the only viable option, in addition to liver transplantation; B: After 4 cycles of chemotherapy, the tumor volume was significantly reduced, but all intrahepatic blood vessels were compressed, making the tumor unresectable; C: Upon re-evaluation after 5 cycles, there was a slight reduction in tumor volume, but the tumor still remained in close proximity to major blood vessels of the liver, preventing surgical resection; D: After 6 cycles, there was no significant change in tumor volume. The tumor was touching the inferior vena cava and portal vein bifurcation, and surgical resection was considered; E: Preoperative simulation of right hemihepatectomy was conducted; F: Intraoperative three-dimensional images were used to assist real-time guidance during the right hemihepatectomy procedure; G and H: The operation proceeded successfully as the preoperative planning, resulting in complete tumor resection while preserving the middle hepatic vein.

Figure 3 A case of hepatoblastoma evaluated the relationship between the tumor and the major blood vessels of the liver after 5 cycles of neoadjuvant chemotherapy. A and B: Contrast-enhanced computed tomography showed that the tumor was still touching three hepatic veins and the inferior vena cava; C: Three-dimensional imaging based on computed tomography images revealed that the left and middle liver veins merged into the inferior vena cava after the common trunk, with a distance of only 0.5117 mm between the tumor and the common trunk; D and E: Preoperative simulated right hemihepatectomy demonstrated that the future liver remnant volume was sufficient at 34%; F-H: The operation proceeded successfully according to preoperative planning, with careful protection of the common trunk and complete removal of the tumor.