Impact of model-based risk analysis for liver surgery planning.

PURPOSE: A model-based risk analysis for oncologic liver surgery was described in previous work (Preim et al. in Proceedings of international symposium on computer assisted radiology and surgery (CARS), Elsevier, Amsterdam, pp. 353­358, 2002; Hansen et al. Int I Comput Assist Radiol Surg 4(5):469­474, 2009). In this paper, we present an evaluation of this method. METHODS: To prove whether and how the risk analysis facilitates the process of liver surgery planning, an explorative user study with 10 liver experts was conducted. The purpose was to compare and analyze their decision-making. RESULTS: The results of the study show that model-based risk analysis enhances the awareness of surgical risk in the planning stage. Participants preferred smaller resection volumes and agreed more on the safety margins' width in case the risk analysis was available. In addition, time to complete the planning task and confidence of participants were not increased when using the risk analysis. CONCLUSION: This work shows that the applied model-based risk analysis may influence important planning decisions in liver surgery. It lays a basis for further clinical evaluations and points out important fields for future research.

Malignant acanthosis nigricans with liver secondaries from an occult primary adenocarcinoma of gastrointestinal tract.

A 38-year-old female presented with hyperpigmented velvety plaques on the nape and the sides of the neck with diffuse pigmentation of the face and flexures suggestive of acanthosis nigricans. The dorsa of both the hands showed increased rugosity, hyperpigmentation and hyperkeratosis of the palms, suggestive of tripe palms. Investigations revealed multiple secondaries in the liver. Histopathology showed the secondaries to be from adenocarcinoma of the gastrointestinal tract.