Impact of three-dimensional reconstruction visualization technology on short-term and long-term outcomes after hepatectomy in patients with hepatocellular carcinoma: a propensity-score-matched and inverse probability of treatment-weighted multicenter study

Abstract

Background: Three-dimensional reconstruction visualization technology (3D-RVT) is an important tool in the preoperative assessment of patients undergoing liver resection. However, it is not clear whether this technique can improve short-term and long-term outcomes in patients with hepatocellular carcinoma (HCC) compared with two-dimensional (2D) imaging.

Method: A total of 3402 patients from five centers were consecutively enrolled from January 2016 to December 2020, and grouped based on the use of 3D-RVT or 2D imaging for preoperative assessment. Baseline characteristics were balanced using propensity score matching (PSM, 1:1) and stabilized inverse probability of treatment-weighting (IPTW) to reduce potential selection bias. The perioperative outcomes, long-term overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Cox-regression analysis was used to identify the risk factors associated with RFS.

Results: A total of 1681 patients underwent 3D-RVT assessment before hepatectomy (3D group), while 1721 patients used 2D assessment (2D group). The PSM cohort included 892 patient pairs. In the IPTW cohort, there were 1608.3 patients in the 3D group and 1777.9 patients in the 2D group. In both cohorts, the 3D group had shorter operation times, lower morbidity and liver failure rates, as well as shorter postoperative hospital stays. The 3D group had more margins ≥10 mm and better RFS than the 2D group. The presence of tumors with a diameter ≥5 cm, intraoperative blood transfusion and multiple tumors were identified as independent risk factors for RFS, while 3D assessment and anatomical resection were independent protective factors.

Conclusion: In this multicenter study, perioperative outcomes and RFS of HCC patients following 3D-RVT assessment were significantly different from those following 2D imaging assessment. Thus, 3D-RVT may be a feasible alternative assessment method before hepatectomy for these patients.

Trial registration: ClinicalTrials.gov NCT05118451.

Graphical abstract

Figure 1

The various application of three-dimensional reconstruction visualization technology (3D-RVT). (A) the 3D-RVT software; (B) the three-dimensional model based on CT image reconstruction; (C) hepatic artery analysis; (D) portal vein analysis; (E) hepatic vein analysis; (F) intrahepatic bile duct analysis; (G) portal vein territory analysis; (H) individualized liver segmentation; and (I) simulated surgery.

Figure 2

Flow diagram of participant selection.

Figure 3

Survival analysis of patients undergoing hepatectomy in the 3D group versus 2D group in the three cohorts. (A) Comparison of OS between the two groups in the entire cohort (P=0.19); (B) Comparison of RFS between the two groups in the entire cohort (P<0.001); (C) Comparison of OS between the two groups in the PSM cohort (P=0.31); (D) Comparison of RFS between the two groups in the PSM cohort (P=0.043); (E) Comparison of OS between the two groups in the IPTW cohort (P=0.156); and (F) Comparison of RFS between the two groups in the IPTW cohort (P<0.001). 3D, three-dimensional; 2D, two-dimensional; OS, overall survival; RFS, recurrence-free survival.