Laparoscopic fenestration of non-parasitic liver cysts and health-related quality of life assessment

Abstract

Although laparoscopic fenestration has become an established treatment in symptomatic liver cyst patients in the recent years, the success of surgical treatment cannot only be evaluated by post-operative morbidity and mortality. Therefore, the aim of this study was to analyze the safety of laparoscopic fenestration of non-parasitic liver cysts and to assess the impact of this therapy on patients' quality of life. A total of 43 patients who underwent laparoscopic fenestration of non-parasitic liver cysts at our center were included in this study. Post-operative course was assessed and patients' quality of life was evaluated before surgery and at present time using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ C-30). The results were that, post-operative morbidity and mortality rates were 0%. After a median follow-up of 49 months (19-97 months) the recurrence rate was 11.1% for simple liver cysts (SLC) and 42.9% for polycystic liver disease (PCLD). Thirty-one out of 43 patients (72.1%) completed the EORTC C-30 questionnaire. There was highly significant post-operative improvement in global health status (p < 0.001) as well as in physical (p = 0.002), role (p = 0.004), emotional (p = 0.003) and social (p = 0.001) functioning. Furthermore, a significant reduction of symptoms could be shown for pain (p < 0.001), nausea and vomiting (p = 0.001), appetite loss (p = 0.006), insomnia (p = 0.04) and fatigue (p = 0.025). To conclude, laparoscopic fenestration of symptomatic non-parasitic liver cysts is a safe procedure with good long-term results and the patients' benefit of this intervention is excellent as shown by highly significant improvement in patients' quality of life.

Somatostatin analogues improve health‐related quality of life in polycystic liver disease: a pooled analysis of two randomised, placebo‐controlled trials

“…The impact of other treatment modalities for PLD on HRQL has not been studied extensively. A few studies on surgical options reported improved HRQL after laparoscopic fenestration and liver transplantation . Two studies reported only postoperative HRQL values while two other studies asked patients to assess their pre‐operative HRQL retrospectively, a method that bears a high risk for bias .…”

“…A few studies on surgical options reported improved HRQL after laparoscopic fenestration and liver transplantation. [30][31][32][33] Two Granuloma 24 19 22 23 Flatulence 22 11 28 15 Loose stools 51 33 56 38 Abdominal cramps 31 8 31 12 Values are expressed in percentage. studies reported only postoperative HRQL values while two other studies asked patients to assess their pre-operative HRQL retrospectively, a method that bears a high risk for bias.…”

Management of giant hepatic cysts in the laparoscopic era

“…The goal of surgical treatment of giant hepatic cysts is to remove as much of the exposed wall as possible and to avoid recurrence [16,20,21]. There is still some controversy about the preferable procedure, but most studies seem to agree on laparoscopic deroofing as the initial approach for the majority of giant liver cysts [22]. …”

“…Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. After deroofing of the cyst what confirmed to adenoma by postoperative histologic findings, although early reintervention has been proposed, surgery may be postponed until symptomatic or radiologic recurrence because of its lower rate of malignancy and relatively long term clinical course to be a cystadenocarcinoma [15,22]. …”

Analysis of unique liver volume restoration after laparoscopic fenestration of liver cysts

“…Laparoscopic fenestration has become a standard surgical procedure for the treatment of symptomatic nonparasitic liver cysts, including polycystic liver disease (1)(2)(3)(4)(5)(6). After the fenestration of giant cysts, remarkable restoration of the remnant liver volume is sometimes observed in addition to the relief of abdominal symptoms (7).…”