The challenge of liver resection in benign solid liver tumors in modern times – in which cases should surgery be done?

Abstract

Due to improved diagnostical and therapeutical approaches, benign liver tumors represent a challenge in clinical management. We here report our experience with patients undergoing liver resection for benign liver tumors. 188 One hundred eighty-eight consecutive patients, who underwent surgery for solid benign liver tumors from 1992 - 2014, were analyzed retrospectively. The focus was on diagnostic pathways, indications for surgery, and perioperative and postoperative quality of life (QoL). Of 188 patients, 100 had focal nodular hyperplasia (FNH) (53.2 %), 33 had hepatocellular adenoma (17.5 %), and 55 had hemangioma (29.3 %). In most patients, there was more than one 1 indication for liver resection, including tumor-associated symptoms (n = 82, 43.6 %), suspicion of malignancy (n = 104, 55.3 %), tumor disease in the medical history (n = 48, 25.5 %), or tumor enlargement (n = 27, 14.4 %). Serious complications (>grade III;, Clavien-Dindo) occurred in 9.5 % of patients. Perioperative mortality was 0.5 %. Patient pain scores decreased over time (p < 0.001). QoL after liver resection significantly improved (p = 0.007). Uncertainty of the tumor entity remains an issue in preoperative diagnostics. If indicated, liver resection for benign liver tumors represents a safe approach and leads to significant improvements of QoL.

Should Focal Nodular Hyperplasia Still be Operated Upon? Analysis of a Case Series

“…In contrast, in case series using conventional exams, Perrakis et al [12], Mezhir et al [6] and Hau et al [11] indicated surgery due to diagnostic doubt in 16.1, 38.2, and 47.8% of patients, respectively; in the study of Bieze et al [13], a large number of patients (66.1%) combined with MRI-LSC in which liver biopsy with immunohistochemistry was used, this incidence was zero. With the incorporation of these tests with higher diagnostic accuracy, a progressive and noticeable reduction of this type of surgical indication is expected.…”

“…In fact, currently, there are no studies with a good level of evidence that can clearly define the best management course for FNH [5,11].…”

“…Classically, the incidence of surgery in patients with presumed FNH remains approximately 21.6-51.4% [6,[11][12][13][14][15]. There are 2 main reasons for this high incidence.…”

“…If there is difficulty in grading a subjective symptom such as pain, there may be concern and fear that the patient has a malignant disease that may be contributing to the intensification of the pain perceived by the patient, an aspect discussed in Hau et al [11]. Although these authors reported that the presence of symptoms was the primary cause for surgical indication in their series (46%), when the operated patients themselves retrospectively filled out a form indicating the cause for the surgery, only 12% cited impaired quality of life, whereas other causes, such as fear of malignant disease, fear of complications without treatment, doctor's recommendation and other concerns, were cited by 82, 19, 43, and 23%, respectively.…”

Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy

“…Therefore, surgical treatment is currently used for liver cancer patients without surgical contraindications. SR for benign liver tumors is safe and can significantly improve the quality of life, 26 so SR is also preferred for benign liver tumors requiring treatment 27 …”