The value of liver resection for focal nodular hyperplasia: resection yes or no?

Abstract

BackgroundFocal nodular hyperplasia (FNH) are benign lesions in the liver. Although liver resection is generally not indicated in these patients, rare indications for surgical approaches indeed exist. We here report on our single-center experience with patients undergoing liver resection for FNH, focussing on preoperative diagnostic algorithms and quality of life (QoL) after surgery.MethodsMedical records of 100 consecutive patients undergoing liver resection for FNH between 1992 and 2012 were retrospectively analyzed with regard to diagnostic pathways and indications for surgery. Quality of life (QoL) before and after surgery was evaluated using validated assessment tools. Student’s t test, one-way ANOVA, χ2, and binary logistic regression analyses such as Wilcoxon–Mann–Whitney test were used, as indicated.ResultsA combination of at least two preoperative diagnostic imaging approaches was applied in 99 cases, of which 70 patients were subjected to further imaging or tumor biopsy. In most patients, there was more than one indication for liver resection, including tumor-associated symptoms with abdominal discomfort (n = 46, 40.7 %), balance of risk for malignancy/history of cancer (n = 54, 47.8 %/n = 18; 33.3 %), tumor enlargement/jaundice of vascular and biliary structures (n = 13, 11.5 %), such as incidental findings during elective operation (n = 1, 0.9 %). Postoperative morbidity was 19 %, with serious complications (>grade 2, Clavien–Dindo classification) being evident in 8 %. Perioperative mortality was 0 %. Liver resection was associated with a significant overall improvement in general health (very good–excellent: preoperatively 47.4 % vs. postoperatively 68.1 %; p = 0.015).ConclusionsLiver resection remains a valuable therapeutic option in the treatment of either symptomatic FNH or if malignancy cannot finally be ruled out. If clinically indicated, liver resection for FNH represents a safe approach and may lead to significant improvements of QoL especially in symptomatic patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40001-015-0181-x) contains supplementary material, which is available to authorized users.

Differential Diagnosis of Clinical, Imaging and Pathological Features Between Focal Nodular Hyperplasia and Hepatocellular Carcinoma

“…However, there were more males than females in this study, which was inconsistent with the literature reports [17], which may be related to the small sample size. HCC is more common in middle-aged and elderly men with acute onset, abdominal pain, and background of hepatitis or cirrhosis, which is similar to that reported in the literature [18][19][20].…”

Changes in the types of liver diseases requiring hepatic resection: a single-institution experience of 9016 cases over a 10-year period

“…The actual prevalence of these diseases in the general population is not low, but only a small proportion of the patients have undergone HR because a majority of these diseases are not indicated for any surgical treatment. 14 15 16 …”

Surgical indications for focal nodular hyperplasia of the liver: Single-center experience of 48 adult cases

“…The authors suggested that hepatic resection was a valuable therapeutic option in the treatment of either symptomatic FNH or when malignancy could not be ruled out. If clinically indicated, liver resection for FNH represents a safe approach and may lead to significant improvement in of quality of life, especially in symptomatic patients 9…”