Impact of three-dimensional hepatic models on oncological outcomes and survival after hepatectomy: Prognostic factor analysis in a retrospective cohort.

Backgrounds/aims: Three-dimensional (3D) modeling is increasingly used in hepatobiliary surgery to enhance anatomical understanding and operative planning. However, its impact on oncologic outcomes remains uncertain. This study evaluated whether preoperative 3D liver models influence resection margin status and survival after hepatectomy for malignant disease.

Methods: In this retrospective case-control study, 59 patients undergoing hepatic resection for malignancy between May 2018 and May 2023 were included. Patients were managed either with patient-specific 3D models (n = 31) or conventional imaging (n = 28). Predictors of R0 resection were analyzed using logistic regression, and overall survival (OS) and disease-free survival (DFS) were assessed using Cox proportional hazards models.

Results: R0 resection was achieved in 79.7% of patients, with no significant difference between groups (77.4% vs. 82.1%; p = 0.865). Bilobar tumor distributionadjusted odds ratio [OR] 0.05, 95% confidence interval [CI] 0.00-0.76; p = 0.039) and a higher albumin-bilirubin score (adjusted OR 0.06, 95% CI 0.00-0.46; p = 0.029) were independently associated with lower odds of achieving R0 resection. In multivariable analysis, the use of 3D models was independently linked to improved 2-year DFS (adjusted hazard ratio 0.47, 95% CI 0.24-0.92; p = 0.028). Tumor type affected recurrence rates, with hepatocellular carcinoma and other tumors showing a lower risk of recurrence compared to colorectal liver metastases. No significant differences in OS were found.

Conclusions: Preoperative 3D modeling was not associated with higher R0 resection rates but was independently associated with improved 2-year DFS. Given the retrospective design and potential residual confounding, these findings should be interpreted cautiously and considered hypothesis-generating pending prospective validation.