Three-Dimensional Printed Liver Models for Surgical Planning and Intraoperative Guidance of Liver Cancer Resection: A Systematic Review

Abstract

Successful liver cancer resection requires a comprehensive pre- and intraoperative understanding of the spatial relationships between a patient’s cancer and intrahepatic anatomy. The recent literature has highlighted that patient-specific 3D-printed liver models (3DPLMs) reconstructed from medical imaging data may enhance the comprehension of patients’ liver anatomy and thereby provide a useful preoperative planning and intraoperative guidance tool for liver cancer resection (LCR). The purpose of this systematic review was to critically examine the utility and feasibility of 3DPLMs for LCR surgical planning and intraoperative guidance and explore whether these applications improve patient outcomes. Articles were retrieved from four electronic databases (Scopus, Embase, PubMed, and Curtin University Database) according to predetermined eligibility criteria. In total, 22 eligible articles were identified, including 11 original research articles and 11 case reports. Key concepts were synthesised using an inductive content analysis approach suitable for this heterogeneous body of literature. There is significant descriptive and case-report evidence that 3DPLMs strengthen pre- and intraoperative comprehension of patient liver and liver tumour anatomy and can enhance pre- and intraoperative surgical decision making for LCR. The analysis of these studies presents large variances in the times and costs necessary to produce 3DPLMs, as studies did not provide the full expenses of materials, software, and equipment. Production times were focused on different aspects of the 3D printing process and were not comparable. The review nonetheless demonstrates the potential value of 3DPLMs as preoperative planning and intraoperative guidance tools for LCR. Future studies should detail these economic data points to ensure 3DPLMs’ viability. Further experimental research and randomised controlled trials are also necessary to examine the relationship between 3DPLMs and patient’s intra- and postoperative outcomes.