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	Non-Surgical Interventions
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

↑ 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.
↑ Reddy KR (2006). "Benign Lesions of the Liver". Gastroenterol Hepatol (N Y). 2 (5): 325–326. PMC 5338186. PMID 28289336.
↑ 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.
↑ 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.
↑ 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.

[pmid16541615-1] 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.

[pmid28289336-2] Reddy KR (2006). "Benign Lesions of the Liver". Gastroenterol Hepatol (N Y). 2 (5): 325–326. PMC 5338186. PMID 28289336.

[pmid23297727-3] 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.

[pmid17188079-4] 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.

[pmid9361515-5] 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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Liver mass surgery

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