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]

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 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:

	Asymptomatic	Symptomatic
		Surgical		Non-Surgical options
		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 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 3-6 months will often be sufficient to confirm the stability of the lesion	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
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 impairement 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