Hepatocellular adenoma surgery: Difference between revisions
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{{CMG}}; {{AOEIC}} {{CZ}} {{ZAS}} | {{CMG}}; {{AOEIC}} {{CZ}} {{ZAS}} | ||
==Overview== | ==Overview== | ||
[[Surgical resection]] is the treatment of choice for | [[Surgical resection]] is the treatment of choice for hepatocellular adenoma larger than 5 cm in [[diameter]], the ones that increase in size, [[Lesion|lesions]] with intra-[[Tumor|tumoral]] [[hemorrhage]], and male [[Patient|patients]] (irrespective of the [[adenoma]] size). [[Liver transplantation]] may be considered for hepatocellular adenomas associated with [[Glycogen storage disease type I|glycogen storage disease type 1]]. [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] and [[Transcatheter arterial chemoembolization|transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) may be considered for [[Patient|patients]] who are poor candidates for [[surgery]]. | ||
== | ==Surgery== | ||
* [[Surgery]] is the treatment of choice for | * [[Surgery]] is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.<ref>{{Cite journal | ||
| 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]] | | 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 | | title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience | ||
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| pmid = 19585623 | | 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> | }}</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 [[Surgery|surgical]] [[resection]] of | * Elective [[Surgery|surgical]] [[resection]] of hepatocellular adenoma is considered for all [[adenoma]] [[Lesion|lesions]] >5cm in [[diameter]], [[Lesion|lesions]] that increase in size, [[Lesion|lesions]] with [[Tumoral|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]] | | 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 | | title = Treatment of ruptured hepatocellular adenoma | ||
| Line 40: | Line 40: | ||
| pmid = 8472159 | | pmid = 8472159 | ||
}}</ref> | }}</ref> | ||
* [[Liver transplantation]] may be considered for patients of | * [[Liver transplantation]] may be considered for patients of hepatocellular adenoma associated with [[Glycogen storage disease type I|glycogen storage disease type 1]].<ref>{{Cite journal | ||
| author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]] | | author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]] | ||
| title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation | | title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation | ||
| Line 53: | Line 53: | ||
}}</ref> | }}</ref> | ||
* In adenoma patients who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered. | * In adenoma patients who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered. | ||
* [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a minimally [[Invasive (medical)|invasive]] technique that can be used for | * [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a minimally [[Invasive (medical)|invasive]] technique that can be used for hepatocellular adenomas, [[hepatocellular carcinoma]] and [[colorectal]] [[Metastasis|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]] | | 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 | | title = Hepatocellular adenoma: when and how to treat? Update of current evidence | ||
Revision as of 02:07, 23 August 2019
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Hepatocellular adenoma Microchapters |
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Hepatocellular adenoma surgery On the Web |
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American Roentgen Ray Society Images of Hepatocellular adenoma surgery |
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Risk calculators and risk factors for Hepatocellular adenoma surgery |
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, 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]
- Liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type 1.[6]
- In 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 hepatocellular adenomas, hepatocellular carcinoma and colorectal metastases as well.[7]
- 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) - ↑ 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)