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

Table 1 Characteristics of children with hepatoblastoma who remain in proximity to the major liver vasculature after a full course neoadjuvant chemotherapy

No.	Sex	Age (m)	Before NAC						NAC regimen (cycle)	After NAC						TGR
			AFP (ng/mL)	PRE-TEXT	MTD (cm)	TV (cm3)	LV (cm3)	LV/TLTV		AFP (ng/mL)	POST-TEXT	MT (cm)	TV (cm3)	LV (cm3)	LV/TLTV
1	M	73	782230	III	10.8	1109.9	360.1	24%	4	35428	III	7	88.4	597.2	87%	-92%
2	F	16	420190	III	8.5	288.3	248.8	46%	4	47	II	3.9	40.3	328.7	89%	-86%
3	F	2	330590	III	9	365.3	137.8	27%	4	27901	II	5.2	27.3	212.3	89%	-93%
4	M	18	238592	III	6.5	149.4	412.2	73%	4	27	II	4	11.4	380.3	97%	-92%
5	M	29	439147	IV	14.1	732.1	536.2	42%	4	46981	III	7.4	126.5	513.4	80%	-83%
6	M	5	326550	III	9.5	287.3	292	50%	4	276	II	4.7	58.9	351.6	86%	-79%
7	F	22	902250	IV	15.1	1203.8	527.3	30%	4	177	II	7	87.9	533.4	86%	-93%
8	M	26	> 484000	III	8	67.1	347.2	84%	3	> 484000	IV	9.3	235.1	250.3	52%	250%
9	F	3	409747	III	10	459.1	94.4	17%	6	260	II	4.2	25.9	208.9	89%	-94%
10	F	32	> 484000	IV	12.8	658.5	469.3	42%	5	15470	IV	8.6	60	541.2	90%	-91%
11	M	42	> 484000	III	11	641.7	508.5	44%	4	3144	II	5.6	79.7	444.4	85%	-88%
12	M	53	269341	IV	13.5	926	633.8	41%	4	89	II	7.3	91.2	736.6	89%	-90%
13	M	57	87696	III	14.8	949.2	599.6	39%	4	245	II	7.2	113.9	541.7	83%	-88%
14	F	44	274020	IV	16.5	1080.6	594.9	36%	5	1730	III	6.6	108.2	503.9	82%	-90%
15	F	67	541614	IV	14.5	1230.1	571.1	32%	5	25124	III	5.8	86.4	727.7	89%	-93%
16	F	33	80075	III	10.3	392.5	260.1	40%	4	13033	II	4.5	54	336.8	86%	-86%

The volume are automatically calculated and displayed based on 3D reconstruction by Hisense CAS. The normal range of AFP is 0-7.02 ng/mL. NAC: Neoadjuvant chemotherapy; AFP: Alpha-fetoprotein; MTD: Maximum tumor diameter; TV: Tumor volume; LV: Tumor-free liver volume; TLTV: Total volume of liver and tumor; FLV: Future liver remnant volume; TGR: Tumor growth rate (the percentage change in tumor volume).

Table 2 The proximity to the major liver vasculature and preoperative evaluation of these 16 hepatoblastoma patients

No.	PMV			Tumor number	Tumor location	Preoperative evaluation and simulated LR
	Classification	Blood vessel	Group			Simulated mode	Surgical planning	FLV (cm3)	FLV/TLTV
1	Within 1 cm	IVC	V0	2	Both lobes	Anatomical LR	Right hepatectomy	373.5	54%
	TT	Right HV	V3
2	Touching	BPV	P1	1	Right lobe	Anatomical LR	Right hepatectomy	177.1	48%
3	Compressing	IVC	V2	1	Middle lobe	Anatomical LR	Extended right hepatectomy	109.7	46%
4	Touching	MPV	P1	1	Middle lobe	Autonomous LR	Extended right hepatectomy; Extended left hepatectomy; Right hepatectomy	288.2	74%
5	Compressing	All intrahepatic veins	V2+P2	1	Middle lobe	Autonomous LR	Right hepatectomy	343	54%
6	Within 1 cm Touching	IVC	V0	1	Right lobe	Anatomical LR		189.3	46%
7	TT	IVC	V1	1	Right lobe	Anatomical LR	Mesohepatectomy	368	59%
	Compressing	Right PV	P3				Right hepatectomy
8	Touching	All intrahepatic veins	V2+P2	1	Middle lobe	Anatomical LR		177.5	37%
9	Touching	IVC	V1	1	Middle lobe	Anatomical LR	Left hepatectomy + VII	90.6	39%
	Touching	BPV	P1				Right hepatectomy
10	Touching	BPV	P1	3	Both lobes	Anatomical LR and		348.8	58%
11	Touching	IVC	V1	1	Right lobe	Tumor dissection	Right hepatectomy	287.9	55%
	Touching	BPV	P1			Anatomical LR	Right hepatectomy
12	Touching	IVC	V1	1	Right lobe			355.1	43%
13	Touching	IVC	V1	1	Right lobe	Anatomical LR	Right hepatectomy + II	224.6	34%
	Touching	All HVs	V1			Anatomical LR	Right hepatectomy
14	Touching	IVC	V1	2	Both lobes			341.5	56%
15	TT	IVC	V1	1	Right lobe	Anatomical LR	Right hepatectomy	480.5	59%
16	Touching	PV	P3			Anatomical LR
	Compressing	IVC	V1	1	Middle lobe			146.9	38%
		BPV	P2			Anatomical LR

PMV: Proximity to the major liver vasculature; LR: Liver resection; FLV: Future liver remnant volume; TLTV: Total volume of liver and tumor; TT: Tumor thrombus; IVC: Inferior vena cava; HV: Hepatic vein; BPV: The bifurcation of the portal vein; MPV: The main of the portal vein; PV: Portal vein.

Table 3 Intraoperative, postoperative and follow-up results of these 16 hepatoblastoma patients

No.	Operation time (min)	Hepatic flow occlusion number and duration	Vascular reconstruction	Blood loss (mL)	Blood transfusion during the operation			Post-operative AFP (ng/mL)	Margin	Pathology	Discharge time (d)	Follow-up
					RBC (U)	Plasma (mL)	CRYO (U)					Time (m)	Result
1	220	1, 15 min	-	20	1	0	0	1075	R0	FE	6	68	Recurrence
2	165	1, 15 min	-	5	0	0	0	1.33	R0	MEN	9	64
3	190	1, 20 min	-	20	0	50	40	505.9	R0	MEM	14	61	Recurrence
4	185	1, 15 min	-	5	0.5	0	0	1.37	R0	MEM	9	52
5	285	2, 20 + 10 min	IVC	100	2	300	2	25.86	R1	MEM	20	46
6	245	2, 13 + 12 min	-	50	1	100	2	0.87	R0	F	21	42
7	230	2, 15 + 10 min	-	100	1	120	0	2.55	R0	FE	13	40
8	250	3, 13 + 12 + 8 min	IVC	200	2	100	0	2517	R0	FE	13	39	Metastasis, death
9	190	1, 15 min	-	10	0.5	0	0	9.15	R0	FE	10	33
10	295	2, 15 + 10 min	-	100	1	0	2	1.55	R0	MEM	9	16
11	280	2, 15 + 10 min	-	100	2	0	0	3.29	R0	MEM	15	16
12	310	1, 15 min	-	50	2	120	2	3.53	R0	F	14	16
13	255	1, 15 min	-	50	1	0	0	1.84	R0	MEM	11	15
14	355	4	IVC, MHV	500	6	770	12	7.43	R0	FE	20	9
15	265	20 + 15 + 18 + 12 min	-	100	1.5	0	0	1642	R0	FE	11	9
16	245	1, 20, 3, 15 + 15 + 9 min	-	30	1	0	0	8.2	R0	F	14	7	Recurrence

RBC: Red blood cell; CRYO: Cryoprecipitate; AFP: Alpha-fetoprotein; IVC: Inferior vena cava; MHC: Middle hepatic vein; F: Pure fetal subtype; FE: Fetal and embryonal subtype; MEM: Mixed epithelial and mesenchymal type.