To explore the application value of three-dimensional (3D) visualization in the preoperative evaluation of hepatectomy for primary liver cancer (PLC).

Clinical data of 80 patients with PLC treated in Shanghai Changzheng Hospital of the Second Military Medical University from January 2015 to December 2017 were retrospectively analyzed. Among them, 57 cases were male and 23 female, aged (51±7) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 40 patients receiving preoperative 3D visualization reconstruction and evaluation were assigned into the 3D reconstruction group. 40 patients who didn't undergo 3D visualization reconstruction were randomly selected by computer into the control group. Perioperative parameters and postoperative complications were statistically compared between two groups. The blood occlusion time and intraoperative blood loss were statistically compared between two groups by rank-sum test or t test. Perioperative liver function parameters were statistically compared between two groups by ANOVA of repeated measurement data. The incidence of postoperative complications and tumor recurrence rate were compared by Chi-square test or likelihood ratio Chi-square test.

The proportion of anatomical hepatectomy in 3D reconstruction group was 68%(27/40), significantly higher than 43%(17/40) in control group (χ2=5.051, P<0.05). However, the rate of positive surgical margin in 3D reconstruction group was 0, significantly lower than 10%(4/40) in control group (χ2= 5.756, P<0.05). The incidence of postoperative complications in 3D reconstruction group was 13%(5/40), significantly lower than 33%(13/40) in the control group (χ2=4.588, P<0.05). In 3D reconstruction group, the median blood occlusion time was 9(0-14) min, significantly shorter than 12(0-15) min in control group (U=1165.5, P<0.05). Intraoperative blood loss was (406±21) ml, considerably less than (549±23) ml in control group (t=-4.977, P<0.05). The liver function parameters including TB, ALT and ALB in 3D reconstruction group recovered faster than those in control group (F=7.408, 30.410, 25.434; P<0.05).

3D visualization contributes to accurate assessment of the risk of hepatectomy for PLC patients and formulating the optimal individualized surgical plan, which can also improve the safety of hepatectomy and reduce the incidence of postoperative complications.