Usefulness of three-dimensional computed tomography for anatomic liver resection: Sub-subsegmentectomy

Background. Precise subtotal hepatectomies based on the vascular anatomy revealed by preoperative three-dimensional computed tomography (3D-CT) were reviewed to examine the usefulness of 3D-CT. Methods. The clinical records and 3D-CT images of 20 patients with 24 hepatomas less than 50 mm in diameter who underwent hepatectomy for hepatocellular carcinoma and metastatic tumors and the usefulness of 3D-CT were assessed. Couinaud's classification of liver subsegments ant Takayasu's classification of sub-subsegments were used as the criteria for the anatomic division. Results. The accuracy in localizing tumors in a small subsegment of the liver was 75% (18 of 24 tumors) for conventional CT and 100% (24 of 24 tumors) for 3D-CT (p < 0.05). 3D-CT images made it possible to perform complete resection confined to the portal unit containing the tumor in patients with poor liver function. This method allowed complete preservation of the circulation of the remnant liver, thus reducing complications. Conclusions. The 3D-CT technique provides more accurate diagnosis and a realistic virtual image of a tumor's location in the liver and so makes possible the anatomic resection of the liver. Because diagnostic errors could result in such clinical complications as postoperative bile leakage, this is a useful technique for hepatectomy, especially for sub-subsegmentectomy.