To evaluate the application value of three-dimensional reconstruction in the conversion resection of advanced primary liver cancer (PLC).

Clinical data of 2 patients with advanced PLC admitted to the Affiliated Hospital of Guizhou Medical University from December 2019 to July 2020 were retrospectively analyzed. The informed consents of 2 patients were obtained and the local ethical committee approval was received. Patient 1: male, aged 52, was admitted to our hospital due to "recurrent upper abdominal pain for 3 months". The right upper quadrant tenderness was reported. Contrast-enhanced CT scan of the upper abdomen detected hepatocellular carcinoma in segment Ⅴ and Ⅵ. The patient was initially diagnosed with China Liver Cancer Staging (CNLC) Ⅲa liver cancer. Patient 2: female, aged 58, was admitted to our hospital due to "space-occupying lesion of the liver for 5 d during physical examination". Contrast-enhanced CT scan of the upper abdomen detected liver cancer in segment Ⅶ and Ⅷ complicated with multiple surrounding foci and involvement of the right branch of portal vein. The initial diagnosis was CNLC Ⅲa liver cancer. Preoperative evaluation were performed in 2 patients with CT three-dimensional reconstruction, which indicated a high risk for right hemihepatectomy. Therefore, TACE combined with anti-HBV conversion therapies were adopted.

After 2 courses of TACE, CT scan of the upper abdomen showed that the tumor volume was decreased and the venous compression was alleviated in patient 1. For patient 2, CT scan of the upper abdomen revealed that the tumor volume was significantly reduced and the relationship between the tumor and the right branch of portal vein compression was alleviated after 3 courses of TACE. CT three-dimensional reconstruction indicated that it was feasible to perform hepatectomy afterward.2 patients underwent resection of segment Ⅴ and Ⅵ, Ⅶ and Ⅷ, respectively. Postoperative TACE adjuvant therapy was given. No postoperative complications, such as acute liver failure, bile leakage and small liver syndrome occurred in two patients. No tumor recurrence or metastasis was reported during 1-year follow-up.

Three-dimensional reconstruction can provide objective information to evaluate the risk of initial surgical regimen and the efficacy of conversion therapy for patients with advanced PLC, and help to make the surgical plan.