title: Outcomes of liver resection in hepatocellular adenoma and focal nodular hyperplasia.
abstract: OBJECTIVE
  The clinical management of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) is still subject to controversy, especially with respect to patient selection for surgery. The aim of this prospective cohort study was to assess the outcomes of surgical intervention.
  
  
  METHODS
  Between January 2008 and September 2012, patients diagnosed with FNH or HCA based on magnetic resonance imaging or computed tomography were enrolled in this prospective study. Resection was undertaken in patients with HCA of > 5 cm or symptomatic lesions. Lesion characteristics, extent of liver resection (minor: fewer than three segments; major: three or more segments), morbidity (by Dindo-Clavien class), mortality, postoperative length of stay and symptoms [McGill Pain Questionnaire, including a visual analogue scale (VAS)] were evaluated.
  
  
  RESULTS
  A total of 110 patients (106 female; median age: 39 years) were included; 51 patients had HCA and 59 had FNH. Of the 110 patients, 49 underwent resection (33 HCA patients; 16 FNH patients). Laparoscopic minor resection was performed in five HCA and five FNH patients; open minor resection was performed in 19 HCA and seven FNH patients, and open major resection was performed in nine HCA and four FNH patients. Severe postoperative complications were observed in four patients (Grade III, n = 3; Grade IV, n = 1). Median baseline scores on the VAS were 6 in FNH patients and 7 in HCA patients; the median VAS score after resection was 0 (P = 0.008).
  
  
  CONCLUSIONS
  If patients with HCA and FNH require surgery, limited resection can be carried out with low morbidity and without mortality. Patients with preoperative symptoms show a high rate of postoperative symptom relief.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Matthanja
authors.initials: M
authors.lastname: Bieze
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Saffire S K S
authors.initials: SS
authors.lastname: Phoa
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D018248:Adenoma, Liver Cell / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome