Background: Recent advance of imaging technology can make a liver surgeon know territories of liver vessels accurately, which had been impossible. Although the impacts of preoperative virtual hepatectomy (VH) on surgical outcomes seem remarkable, they have not yet been evaluated.

Methods: In Tokyo University Hospital, we have applied the methods of VH in 1,194 cases since 2004. Outcomes after surgery for hepatocellular carcinoma (HCC) and colorectal liver metastases (CLM) were compared between patients with and without VH. In recipients undergoing living donor liver transplantation (LDLT), surgical outcomes were also compared.

Results: In HCC patients with impaired liver function, anatomical resection was conducted more frequently in the VH group than in the non-VH. The 5-year disease-free survival (DFS) rate of the VH group was higher than the non-VH (37.2% vs 23.9%, p=0.04). In CLM patients, major hepatectomy and co-resection of the hepatic veins were more often conducted in the VH group than in the non-VH. The 5-year overall survival and DFS rates were similar between the two groups (41.0% vs 62.7% [p=0.06], 31.5% vs 31.8% [p=0.74]). In LDLT, venous reconstruction was more frequently performed in the VH group than the non-VH (51% vs. 37%, p<0.01). No significant differences were found in non-congestive liver remnant volume and postoperative course.

Conclusion: VH for HCC seemed to prolong DFS by increasing anatomical resection even with impaired liver function. An aggressive surgical approach to advanced CLM was achieved by VH. In LDLT, VH optimized venous reconstruction, leading to the less invasive surgery.