Hepatocellular adenoma surgery: Difference between revisions
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==Hepatocellular adenoma surgery== | ==Hepatocellular adenoma surgery== | ||
* Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.<ref name=cde>{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164 }} </ref> | * Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.<ref>{{Cite journal | ||
* Elective surgical resection of hepatocellular adenoma is considered for; all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size). | | author = [[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]] | ||
| title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience | |||
| journal = [[Hepatology (Baltimore, Md.)]] | |||
| volume = 50 | |||
| issue = 2 | |||
| pages = 481–489 | |||
| year = 2009 | |||
| month = August | |||
| doi = 10.1002/hep.22995 | |||
| pmid = 19585623 | |||
}}</ref><ref name=cde>{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164 }} </ref> | |||
* Elective surgical resection of hepatocellular adenoma is considered for; all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size).<ref>{{Cite journal | |||
| author = [[T. Terkivatan]], [[J. H. de Wilt]], [[R. A. de Man]], [[R. R. van Rijn]], [[H. W. Tilanus]] & [[J. N. IJzermans]] | |||
| title = Treatment of ruptured hepatocellular adenoma | |||
| journal = [[The British journal of surgery]] | |||
| volume = 88 | |||
| issue = 2 | |||
| pages = 207–209 | |||
| year = 2001 | |||
| month = February | |||
| doi = 10.1046/j.1365-2168.2001.01648.x | |||
| pmid = 11167868 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[J. Belghiti]], [[D. Pateron]], [[Y. Panis]], [[V. Vilgrain]], [[J. F. Flejou]], [[J. P. Benhamou]] & [[F. Fekete]] | |||
| title = Resection of presumed benign liver tumours | |||
| journal = [[The British journal of surgery]] | |||
| volume = 80 | |||
| issue = 3 | |||
| pages = 380–383 | |||
| year = 1993 | |||
| month = March | |||
| pmid = 8472159 | |||
}}</ref> | |||
* The liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type1. | * The liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type1. | ||
* The adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered. | * The adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, 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 hepaocellular adenomas, hepatocellular carcinoma and colorectal metastases as well. | * Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepaocellular adenomas, hepatocellular carcinoma and colorectal metastases as well.<ref>{{Cite journal | ||
| author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]] | |||
| title = Hepatocellular adenoma: when and how to treat? Update of current evidence | |||
| journal = [[Therapeutic advances in gastroenterology]] | |||
| volume = 9 | |||
| issue = 6 | |||
| pages = 898–912 | |||
| year = 2016 | |||
| month = November | |||
| doi = 10.1177/1756283X16663882 | |||
| pmid = 27803743 | |||
}}</ref> | |||
* Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions. | * Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions. | ||
Revision as of 16:14, 11 January 2019
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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
There is no specific medical therapy for the hepatocellular adenomas. The wait and watch policy is recommended for hepatocellular adenoams <5cm following cessation of offending drugs (OCPs) and no further growth detected. Annual followup is scheduled with MRI or ultrasound until menopause.
Hepatocellular adenoma surgery
- Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.[1][2][3]
- Elective surgical resection of hepatocellular adenoma is considered for; all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size).[4][5]
- The liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type1.
- The adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, 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 hepaocellular adenomas, hepatocellular carcinoma and colorectal metastases as well.[6]
- Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions.
- The algorithm approach to management of hepatocellular adenoma based on clinical features, gender, imaging and histology.
| MRI features of hepatic adenoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Asymptomatic | Symptomatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Male & glycogen storage disease | Female | Hemodynamically stable | Hemodynamically unstable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Resection irrespective of size & sybtype | Stop offending drugs | Radiofrequency ablation resection | Embolization resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| <5cm | >5cm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Steatotic (HNF1 a) Hepatic adenoma | Inflammatory hepatic adenoma | Beta catenin hepatic adenoma | Otehrs | Consider resection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Followup, genetic counselling for MODY & hepatic adenomatosis | Close followup, treatment of obesity & discontinue 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) - ↑ 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)