Conservative and operative management of benign solid hepatic tumours: a successful stratified algorithm.
BACKGROUND
The progress of modern imaging studies has improved the diagnostic approach of benign liver tumours, leading to a tailored approach with increased conservative management.


METHODS
One hundred and thirty-two patients suffering from benign hepatic tumours were enrolled in this study, including an operative (group I, 49 patients) and a conservative (group II, 83 patients) management. Patients' tumour and treatment features were analyzed.


RESULTS
The mean patients' age was 39 years. Indication for resection based on diagnosis of tumour nature (hepatic cell adenoma or uncertain diagnosis) and significant tumour-related abdominal pain was 15% out of 33 patients with hepatic haemangioma, 21.7% out of 60 patients with focal nodular hyperplasia and 78.4% out of 37 patients with hepatocellular adenoma. Mortality was nihil in group I. Complications and transfusion rates were related to the performance of major hepatectomy, when required for huge tumours. With a 95.5% of complete patients' follow-up during a mean of 92 months in group I and 87 months in group II, no misdiagnosis or evolution towards malignancy was encountered. Interestingly, 87.9% of all observed benign liver tumours remained stable, decreased in size or disappeared. None of the remaining lesions required surgery.


CONCLUSIONS
A restrictive policy of surgical management of benign liver tumours based on clinical symptoms, tumour size and nature on imaging studies (including dubious lesions) and tumour biopsies in selected cases is safe and reliable with a low-operative mortality in resected patients and satisfactory disease-control in the vast majority of observed benign liver tumours.
Dardenne
Sabrina
S
Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
Hubert
Catherine
C
Sempoux
Christine
C
Annet
Laurence
L
Jouret-Mourin
Anne
A
Horsmans
Yves
Y
Van Beers
Bernard E
BE
Zech
Francis
F
Gigot
Jean-François
JF
D018248:Adenoma, Liver Cell / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000465:Algorithms; D001530:Belgium; D001706:Biopsy; D016009:Chi-Square Distribution; D019091:Critical Pathways; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome