A multicentre retrospective analysis on growth of residual hepatocellular adenoma after resection

Abstract

Background & Aims Hepatocellular adenoma (HCA) is a benign liver tumour that may require resection in select cases. The aim of this study was to the assess growth of residual HCA in the remnant liver and to advise on an evidence‐based management strategy. Method This multicentre retrospective cohort study included all patients with HCA who underwent surgery of HCA and had residual HCA in the remnant liver. Growth was defined as an increase of >20% in transverse diameter (RECIST criteria). Data on patient and HCA characteristics, diagnostic work‐up, treatment and follow‐up were documented and analysed. Results A total of 134 patients were included, one male. At diagnosis, median age was 38yrs (IQR 30.0‐44.0) and median BMI was 29.9 kg/m2 (IQR 24.6‐33.3). After resection, median number of residual sites of HCA was 3 (IQR 2‐6). Follow‐up of residual HCA showed regression in 24.6%, stable HCA in 61.9% and growth of at least one lesion in 11.2%. Three patients (2.2%) developed new HCA that were not visible on imaging prior to surgery. Four patients (3%, one male) underwent an intervention as growth was progressive. No statistically significant differences in clinical characteristics were found between patients with growing residual or new HCA versus those with stable or regressing residual HCA. Conclusion In patients with multiple HCA who undergo resection, growth of residual HCA is not uncommon but interventions are rarely needed as most lesions stabilize and do not show progressive growth. Surveillance is indicated when residual HCA show growth after resection, enabling intervention in case of progressive growth.

Hepatocellular adenoma: what we know, what we do not know, and why it matters

“…The most common risk factor for developing HCAs in Western countries is by far oestrogen in oral contraceptives (OCs) with the highest rate of use being in European countries 5–7 . Following the discontinuation of OCs, which is now part of the recommended management of HCAs, 8 HCAs may remain stable, regress, grow, or recur 9–14 . HCAs are rare in or after the menopause 15 …”

Regression of multiple hepatocellular adenomas after cessation of oral contraceptive pills : a case report and review of the current literature

“…A retrospective study of 44 patients by Shao et al (10), indicated that lesions with important fat infiltration (characteristic for H-HCA) showed a significant less size decrease after OCP cessation compared to those without fat infiltration. The team of Klompenhouwer et al (13) found a difference for HCA regression in different subtypes, in favour of I-HCA and unclassified HCA, although in a retrospective study of 134 patients no statistically significant differences could be found (12).…”

“…Furthermore, most series included both single and multiple HCAs which complicates the interpretation. An overview of the current literature about the evolution of multiple HCAs and correlation with the different subtypes is presented in table 2 (5,8,(10)(11)(12). Information about the impact of OCP withdrawal on the different subtypes is scarce.…”

“…The locoregional therapies may induce growth of the residual HCAs. A recent retrospective study by Klompenhouwer et al (12), of 134 patients with multiple HCAs (with 52 % I-HCA and 87% on oral contraceptives), evaluated the effect on the remaining lesions in the remnant liver after resection. After a median follow-up of 6 months they reported a regression in 24.6% of patients, stable disease in 61.9%, progression in 11.2% and in 2.2% new lesions developed.…”

Base molecular de los adenomas hepatocelulares y su implicación médico-quirúrgica

“…Después de la resección está indicada la vigilancia del adenoma residual, y en caso de crecimiento progresivo se debe reintervenir. (41) Hay casos publicados de CHC que surgen después de adenomas múltiples resecados, considerándose que representan focos de CHC resecados dentro de adenomas. También, se ha publicado la regresión de estos tumores con la suspensión de los esteroides por vía oral.…”