Liver mass surgery
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Liver Mass Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Liver mass surgery On the Web |
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American Roentgen Ray Society Images of Liver mass surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
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
Surgical options
- Embolization
- ERCP
- Liver resection
- Liver transplantation
Indications for Surgery
- Bleeding tumor
- Solitary Symptomatic Tumors
| Asymptomatic | Symptomatic | |||
|---|---|---|---|---|
| Surgical | Non-Surgical options | |||
| Indications | Options | |||
| Hepatic adenoma | The European Association for Study of the Liver recommends
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| Hepatic Hemangioma |
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| Focal nodular hyperplasia | ||||
Hepatic adenoma
Asymptomatic woman on OCPs with a small 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 magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
- Patients with hepatic adenomas that do not resolve or that enlarge after six months of observation should undergo treatment.
Symptomatic patients and those with large adenomas
- Surgical resection is recommended for all symptomatic patients with hepatic adenoma and those with large lesions (>5 cm).
- Surgical options include :
- Enucleation
- Resection
- Liver transplantation
- Nonsurgical interventions include
- Transarterial embolization
- Radiofrequency ablation
Hepatic Hemangioma
- Asymptomatic patients
- Patients with lesions <1.5 cm, are reassured and observed.
- Follow-up imaging in patients with hemangiomas ≤5 cm in size is usually not recommended.
- Patients with rapid growth of a hemangioma or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
- It is recommended not perform additional imaging if there is no change in the size of the lesion.
- Symptomatic patients
- Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
- Surgical options include
- Liver resection
- Enucleation
- Hepatic artery ligation
- Liver transplantation
- Non-surgical techniques include
- Hepatic artery embolization
- Radiotherapy
- Interferon alfa-2a
Focal nodular hyperplasia
- Due to their benign nature of focal nodular hyperplasia, there is no indication for therapy unless they are symptomatic.
- Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
- Surgery should be reserved for symptomatic FNH lesion.