title: Management and long-term follow-up of hepatic cysts.
abstract: OBJECTIVE
  To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years.
  
  
  METHODS
  We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-up hepatic ultrasonography.
  
  
  RESULTS
  Forty-four patients (36 females, 8 males) underwent a total of 46 operations for hepatic cysts (mean size 12.0 +/- 5.2 cm) with a mean follow-up of 5.1 +/- 4.0 years. We treated 28 simple cysts, 4 polycystic liver disease (PCLD), 7 cystadenomas, 2 hydatid cysts, 1 cystadenocarcinoma, 1 endometrioma, and 1 hepatic foregut cyst. Operations included simple drainage, wide unroofing (open and laparoscopic), and hepatic resection. Four patients experienced a symptomatic recurrence after definitive treatment; 3 of these patients had PCLD. Four of the 7 patients with cystadenomas had undergone previous operations that required subsequent definitive resection without a recurrence.
  
  
  CONCLUSIONS
  The preoperative distinction between simple cysts and cystadenomas/cystadenocarcinomas can be difficult, yet the management is different. Unroofing is a safe and effective operation for patients with simple cysts. Patients with PCLD frequently have recurrences. Cystadenomas should be completely resected owing to the likelihood of recurrence after partial excision and the risk of eventual cystadenocarcinoma. We present a treatment algorithm for the preoperative evaluation and management of hepatic cysts based on the largest number of patients with the longest follow-up reported to date.
authors.affiliation: Virginia Mason Medical Center, Virginia Mason Clinic, Buck Pavilion, 6th Floor, 1100 Ninth Ave, Seattle, WA 98101, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Hansman
authors.forename: J A
authors.initials: JA
authors.lastname: Ryan
authors.forename: J H
authors.initials: JH
authors.lastname: Holmes
authors.forename: S
authors.initials: S
authors.lastname: Hogan
authors.forename: F T
authors.initials: FT
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Kramer
authors.forename: T
authors.initials: T
authors.lastname: Biehl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003536:Cystadenocarcinoma / Q000473:pathology / Q000601:surgery*; D003537:Cystadenoma / Q000473:pathology / Q000601:surgery*; D003560:Cysts / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome