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Background: Breast-conserving surgery after primary systemic therapy (PST) has become a widely acceptable procedure for locally advanced breast cancers. Sometimes it is difficult to determine the appropriate resection-line at the time of surgical operation because of tumor size reduction or indistinct boundary of the tumor. Moreover we cannot detect tumors in cases with complete response. That was why we developed a new navigation technique using real-time image reconstruction. Materials and methods: Multi-detector row computed tomography (MD-CT) has been performed for all breast cancer patients in our institute. DICOM images of MD-CT were analyzed by image processing software ‘OsiriX'. OsiriX is an open source software which anyone can download from website (http://www. osirix-viewer.com). OsiriX has been specifically designed for navigation and visualization of multimodality and multidimensional images. We used 3D volume rendering images. At the time of surgery, pre-PST volume rendering images ware superimposed directly on the patients’ skin from projector which was connected to a personal computer in the operating room. Results: We could see ‘real-time’ rendering images (from skin to organ by layer to layer) on the patient's body. By using pre-PST imaging data, we could recognize precise tumor area and could perform breast conserving surgery safer and easier than before. Conclusion: Using 3D reconstruction MD-CT images which were obtained before PST, ‘real-time’ virtual navigation was helpful to determine the resection-line for clear surgical margin in breast-conserving surgery after PST. This new technique does not need some expensive equipments and easily performed by surgeon. Ordinary personal computer and projector make it possible to demonstrate a new environment in surgical operation. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-11.

Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) has been recently introduced, and has demonstrated that it produces rapid future remnant liver (FRL) volumes compared with conventional staged hepatectomy using portal vein embolization (PVE). The correlation between the change of volume and functional capacity in ALPPS is not clear. Furthermore, exact mechanisms of the spectacular regenerative response in ALPPS have not been elucidated. The aim of this study is to evaluate whether FRL volume increases with its change of functional capacity in ALPPS compared with PVE and to elucidate the mechanism of the regenerative response in ALPPS. A retrospective review of all patients with liver metastases undergoing ALPPS or conventional staged hepatectomies using PVE was performed. ALPPS consisted of 2 steps; parenchymal transection between the FRL and the diseased part of the liver with concomitant selective PVL was performed. After that, the diseased deportalized part of the liver was removed 7 - 10 days later. In contrast, the diseased deportalized part of the liver was removed 4 - 6 weeks after PVE for the conventional staged hepatectomy. The fusion data of multi-detector raw CT and 99mTc-GSA dynamic SPECT using the software, SYNAPSE VINCENT (Fujifilm, Japan) was analyzed. FRL volume was measured by CT volumetry at 1 week after 1st step of ALPPS and 4 weeks after PVE. Seven patients with ALPPS were compared with 6 patients with conventional staged hepatectomies. The increasing rate of FRL volume was higher in ALPPS than in PVE (13.7% and 4.6%, respectively), whereas the increasing rate of the functional capacity of FRL was higher in PVE than in ALPPS (18.5% and 10.7%, respectively). This result suggests that the increasing rate of the functional capacity of FRL might be lower compared with the volume, resulting in an overestimation of the functional capacity of FRL for ALPPS. To elucidate the mechanism of the regenerative response and figure out which day is the best time for the diseased liver resection after 1st step of ALPPS, rats were randomly assigned to three experimental groups: selective PVL and ALPPS, sham operation. The hepatic regeneration rate, histopathology, liver biochemical determinations were assessed at 24, 48 and 72h after surgery. The hepatic regeneration rate of ALPPS was much higher than that of the PVL at 72h after surgery. And we successfully established the ALPPS model using rats and demonstrated the accelerated hepatic regeneration in ALPPS compared with PVL. Our model provides a basis for further studies of ALPPS. Citation Format: Daisuke Kawaguchi, Yukihiko Hiroshima, Takashi Murakami, Kenichi Matsuo, Chihiro Kosugi, Kiyohiko Syuto, Akimitsu Yamada, Itaru Endo, Keiji Koda, Kuniya Tanaka. The correlation between the change of future remnant liver volume and functional capacity in ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), and establishment of ALPPS model in rats. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5272. doi:10.1158/1538-7445.AM2015-5272