Liver mass surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation. Surgery is the mainstay of treatment for symptomatic benign liver lesions.

Surgery

In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation. Surgery is the mainstay of treatment for symptomatic benign liver lesions.

  • Management of lesions also depends upon:
    • Symptoms
    • Size
    • Number
    • Location
    • Certainty of the diagnosis

The following table summarizes surgical management of most common benign liver lesions that cause liver mass:[1][2][3][4][5]

Disease Asymptomatic Symptomatic
Surgical Interventions Non-Surgical Interventions
Indications Options
Hepatic adenoma The European Association for Study of the Liver recommends:
  • Discontinuation of contraceptive medication
  • Close observation of the lesion with repeated imaging and alpha-fetoprotein
    • Contrast-enhanced MRI at a six 6 month interval to determine if there is a regression
  • Symptomatic patients
  • Large lesions (>5 cm)
  • Enucleation
  • Resection
  • Liver transplantation
  • Transarterial embolization
  • Radiofrequency ablation
Hepatic Hemangioma
  • Patients with lesions <1.5 cm
    • Reassurance
    • Observation
  • Patients with a rapid growth of a hemangioma or with lesions >5 cm
    • Repeat imaging in 6 to 12 months
  • Abdominal pain
  • Symptoms suggestive of extrinsic compression of adjacent structures
  • Liver resection
  • Enucleation
  • Hepatic artery ligation
  • Liver transplantation
  • Hepatic artery embolization
  • Radiotherapy
  • Interferon alfa-2a 
Focal nodular hyperplasia
  • No indication for therapy unless they are symptomatic
  • Follow-up imaging studies
    • Confirm the stability of the lesion after 3-6 months
  • N/A
  • N/A
  • N/A
Simple Hepatic cyst
  • No treatment
  • Cysts >4 cms in diameter
    • Periodic USG 3 months after initial diagnosis
    • 6-12 months follow up
    • If cyst remained stable, no further treatment/followup
  • Abdominal pain
  • Growing cyst
  • Needle aspiration with or without injection of sclerosing agents
  • Internal drainage with cystojejunostomy
  • Wide unroofing/cyst resection
  • Liver resection 
  • N/A
Non-Invasive Cystadenoma
  • Surgery
    • High potential of malignant transformation
  • N/A
  • Removal of the cyst
    • Partial excision
    • Complete excision
  • Aspiration
  • Hepatic resection
    • Considered whenever a cystic lesion is suspected of containing invasive carcinoma
  • N/A
Invasive cystadenoma
  • N/A
  • N/A
  • Liver resection
  • Radiation
  • Chemotherapy
Hepatic abscess
  • N/A
  • Percutaneous
    •  Abscess size is more than 5 cm
  • Surgical drainage
    • Ruptured abscess
    • Hyperbilirubinemia or renal impairment
    • Multiple and loculated abscesses which cannot be easily accessible by percutaneous drainage
    • Inadequate drainage through percutaneous methods
  • ERCP
    • Bile duct stones 
    • Strictures
  • Percutaneous Drainage
  • Surgical Drainage
  • ERCP
  • N/A

References

  1. Skalicky T, Treska V, Sutnar A, Liska V, Mirka H, Ohlidalova K, Ferda J (2005). "Surgical treatment of benign liver tumors". Bratisl Lek Listy. 106 (10): 330–2. PMID 16541615.
  2. Reddy KR (2006). "Benign Lesions of the Liver". Gastroenterol Hepatol (N Y). 2 (5): 325–326. PMC 5338186. PMID 28289336.
  3. Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR (2013). "Changes in the management of benign liver tumours: an analysis of 285 patients". HPB (Oxford). 15 (2): 156–63. doi:10.1111/j.1477-2574.2012.00556.x. PMC 3719923. PMID 23297727.
  4. Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF (2007). "Liver resection for benign liver tumors: indications and outcome". Am. J. Surg. 193 (1): 5–9. doi:10.1016/j.amjsurg.2006.04.017. PMID 17188079.
  5. Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R (1997). "Benign liver tumors: differential diagnosis and indications for surgery". World J Surg. 21 (9): 983–90, discussion 990–1. PMID 9361515.

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