Virtual hepatectomy and metastasectomy 3D simulation using an automated and semiautomated tool applied to preoperative CT in the treatment of colorectal cancer metastases

Colorectal cancer represents the most common malignancy of the gastrointestinal tract and the second most frequently diagnosed malignancy in adults. The most common site of metastases is the liver and 40% of patients in stage IV have liver only disease.( 1 ) Hepatic metastases are the major determinants of morbidity and mortality in these patients, with surgery being the treatment of choice or even curative in these cases.( 2 ) Therefore, aggressive surgeries should be considered in patients with liver only disease. In this context, hepatectomy and metastasectomy have emerged as promising techniques for improving survival in patients with metastatic disease, also providing long-term cure.( 3 ) The use of liver volumetrics, tridimensional reconstructions with vessel extraction and 3D virtual surgery simulations allows better surgical planning and potentially decrease transfusions, surgery time and complications.( 4 ) For major hepatectomies (>4 resected segments), surgical planning with computed angiotomography and liver remnant volume calculation potentially increases the safety of surgery. We report a case in which preoperative 3D surgical simulation was crucial for conducting a safe major hepatectomy in a patient with multiple colorectal liver metastases.