Hepatocellular adenoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Zahir Ali Shaikh, MD[3]
Overview
Surgical resection is the treatment of choice for hepatocellular adenoma larger than 5 cm in diameter, the ones that increase in size, lesions with intra-tumoral hemorrhage, and male patients (irrespective of the adenoma size). Liver transplantation may be considered for hepatocellular adenomas associated with glycogen storage disease type 1. Radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered for patients who are poor candidates for surgery.
Surgery
- Surgery is the treatment of choice for hepatocellular adenoma.[1][2][3]
- Elective surgical resection of hepatocellular adenoma is considered for all adenoma lesions with the following characteristics:[4][5]
- Lesions > 5 cm in diameter
- Lesions that increase in size
- Lesions with intratumoral hemorrhage
- Male patients (irrespective of adenoma size)
- Liver transplantation may be considered for hepatocellular adenoma associated with glycogen storage disease type 1.[6]
- In adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, and morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered.
- Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepatocellular adenoma, hepatocellular carcinoma, and colorectal metastases as well.[7]
- Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hyper-vascular arterial lesions.
Approach to the Management of Hepatocellular Adenoma Based on Clinical Features, Gender, Imaging Features, and Histology:
| MRI features of hepatic adenoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Asymptomatic | Symptomatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Male & glycogen storage disease | Female | Hemodynamically stable | Hemodynamically unstable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Resection irrespective of size & subtype | Stop offending drugs | Radiofrequency ablation resection | Embolization resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| < 5 cm | > 5 cm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Steatotic (HNF1 a) Hepatic adenoma | Inflammatory hepatic adenoma | Beta catenin hepatic adenoma | Others | Consider resection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Followup, genetic counselling for MODY & hepatic adenomatosis | Close followup, treatment of obesity | Biopsy & resection if confirmed | Biopsy & treat based on subtype | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Paulette Bioulac-Sage, Herve Laumonier, Gabrielle Couchy, Brigitte Le Bail, Antonio Sa Cunha, Anne Rullier, Christophe Laurent, Jean-Frederic Blanc, Gaelle Cubel, Herve Trillaud, Jessica Zucman-Rossi, Charles Balabaud & Jean Saric (2009). "Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience". Hepatology (Baltimore, Md.). 50 (2): 481–489. doi:10.1002/hep.22995. PMID 19585623. Unknown parameter
|month=ignored (help) - ↑ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text
- ↑ Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.
- ↑ T. Terkivatan, J. H. de Wilt, R. A. de Man, R. R. van Rijn, H. W. Tilanus & J. N. IJzermans (2001). "Treatment of ruptured hepatocellular adenoma". The British journal of surgery. 88 (2): 207–209. doi:10.1046/j.1365-2168.2001.01648.x. PMID 11167868. Unknown parameter
|month=ignored (help) - ↑ J. Belghiti, D. Pateron, Y. Panis, V. Vilgrain, J. F. Flejou, J. P. Benhamou & F. Fekete (1993). "Resection of presumed benign liver tumours". The British journal of surgery. 80 (3): 380–383. PMID 8472159. Unknown parameter
|month=ignored (help) - ↑ Jan P. Lerut, Olga Ciccarelli, Christine Sempoux, Etienne Danse, Jacques deFlandre, Yves Horsmans, Etienne Sokal & Jean-Bernard Otte (2003). "Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation". Transplant international : official journal of the European Society for Organ Transplantation. 16 (12): 879–884. doi:10.1007/s00147-003-0613-3. PMID 12904843. Unknown parameter
|month=ignored (help) - ↑ Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter
|month=ignored (help)