Three-dimensional visualization and evaluation (3DVE) are better than contrast-enhanced computed tomography at assessing the resectability of hilar cholangiocarcinoma (hCCA), according to a new study published in the World Journal of Surgical Oncology

Preoperative 3DVE showed that the involvement of the hepatic artery is an independent risk factor for the absence of R0 margin, which indicates a microscopically margin-negative resection, in which no gross or microscopic tumor remains in the primary tumor bed. 

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The authors also added that the classification of hCCA using 3DVE is “valuable in clinical practice.”

They retrospectively analyzed 111 patients to determine resectability according to revised criteria for unresectability of hCCA. 

They then reconstructed 3-dimensional visualization models to evaluate 4 resectability parameters. These were biliary infiltration, vascular involvement, hepatic atrophy, and metastasis. 

Finally, they compared the accuracy of the evaluation between contrast-enhanced computed tomography and 3DVE.

They analyzed the outcomes in a cohort of 34 patients.

They found that the accuracy of 3DVE evaluating the resectability of hCCA preoperatively was 91%. This rate was significantly higher than with computed tomography, which was 81%. 

The researchers identified hepatic artery involvement in 3DVE as an independent risk factor for R1 or R2 resection. 

They said the new 3DVE hCCA classification could predict the R0 resection rate and prognosis.

CCA is a group of rare malignant tumors that originate from cells of the biliary tree. hCCA, also known as Klatskin tumors, occur in the bile ducts that lead out of the liver and join with the gallbladder.

3DVE is a digital image processing technology that is used for hepatobiliary diseases. It integrates the raw images of computed tomography or magnetic resonance imaging to reconstruct the lesion, vessels, and complex liver anatomy, to create a stereoscopic model that can display the spatial relationship between lesions and adjacent tissues.


Zhang JZ, Yang CX, Gao S, et al. Three-dimensional visualization and evaluation of hilar cholangiocarcinoma resectability and proposal of a new classification. World J Surg Oncol. Published online August 5, 2023. doi:10.1186/s12957-023-03126-2