title: Surgical management of hepatocellular adenoma: take it or leave it?
abstract: BACKGROUND
  Hepatocellular adenoma (HA) is a rare benign tumor of the liver. Surgical resection is generally indicated to reduce risks of hemorrhage and malignant transformation. We sought to evaluate clinical presentation, surgical management, and outcomes of patients with HA at our institution.
  
  
  METHODS
  We performed a retrospective review of 41 patients who underwent surgical resection for HA between 1988 and 2007.
  
  
  RESULTS
  Thirty-eight patients were women, and the median age at presentation was 36 years (range, 19-65 years). The most common clinical presentation was abdominal pain (70%) followed by incidental radiological finding (17%). Twenty-two patients had a history of oral contraceptive use. Median number of HA was one (range, 1-3). There were 32 open cases (3 trisectionectomy, 15 hemihepatectomy, 7 sectionectomy, 4 segmentectomy, and 3 wedge resection), and 9 laparoscopic cases (1 hemihepatectomy, 5 sectionectomy, 1 segmentectomy, and 2 wedge resection). The median estimated blood loss was 225 mL (range, 0-3400 mL). The median length of stay was 6 days (range, 1-15 days). Surgical morbidities included pleural effusion requiring percutaneous drainage (n = 2), pneumonia (n = 1), and wound infection (n = 1). There was no perioperative mortality. Twelve patients had hemorrhage from HA. Hepatocellular carcinoma was observed in two patients with HA. Median follow-up was 23 months (range, 1-194 months), at which time all patients were alive.
  
  
  CONCLUSIONS
  In view of 29% hemorrhagic and 5% malignant complication rates, we recommend surgical resection over observation if patient comorbidities and anatomic location of HA are favorable. A laparoscopic approach can be safely used in selected cases.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
authors.forename: Sung W
authors.initials: SW
authors.lastname: Cho
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steel
authors.forename: Shane E
authors.initials: SE
authors.lastname: Holloway
authors.forename: Jason T
authors.initials: JT
authors.lastname: Heckman
authors.forename: Erin R
authors.initials: ER
authors.lastname: Ochoa
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome