European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group.
Hepatocellular adenoma (HCA) is a benign hepatic lesion that may be complicated by bleeding and malignant transformation. The aim of the present study is to report on large series of liver resections for HCA and assess the incidence of hemorrhage and malignant transformation.



A retrospective cross-sectional study, from 27 European high-volume HPB units.



573 patients were analyzed. The female: male gender ratio was 8:2, mean age: 37 ± 10 years. Of the 84 (14%) patients whose initial presentation was hemorrhagic shock (Hemorrhagic HCAs), hemostatic intervention was urgently required in 25 (30%) patients. No patients died after intervention. Tumor size was >5 cm in 74% in hemorrhagic HCAs and 64% in non-hemorrhagic HCAs (p < 0.001). In non-hemorrhagic HCAs (n = 489), 5% presented with malignant transformation. Male status and tumor size >10 cm were the two predictive factors. Liver resections included major hepatectomy in 25% and a laparoscopic approach in 37% of the patients. In non-hemorrhagic HCAs, there was no mortality and major complications occurred in 9% of patients.



Liver resection for HCA is safe. Presentation with hemorrhage was associated with larger tumor size. In males with a HCA >10 cm, a HCC should be suspected. In such situation, a preoperative biopsy is preferable and an oncological liver resection should be considered.
Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France; INSERM, UMR 955, Créteil, France. Electronic address: alexis.laurent@aphp.fr.
Alexis
A
Laurent
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
Safi
S
Dokmak
Department of hepatology, Hôpital Jean Verdier, Bondy, France; Inserm, UMR-1162, Paris, France.
Jean-Charles
JC
Nault
Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, Lille, France.
François-René
FR
Pruvot
Department of Digestive Surgery and Transplantation, St Eloi Hospital, Montpellier, France.
Jean-Michel
JM
Fabre
Clinique d'Hépatogastroentérologie, pôle DigiDune, CHU de Grenoble, France.
Christian
C
Letoublon
Department of Surgery, University Hospital of Hautepierre, Strasbourg, France.
Philippe
P
Bachellier
Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.
Lorenzo
L
Capussotti
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
Olivier
O
Farges
Department of Surgery, Hôpital de la Croix Rousse, Lyon, France.
Jean-Yves
JY
Mabrut
Department of Surgery, Hôpital de la Timone, Marseille, France.
Yves-Patrice
YP
Le Treut
Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Université de Lorraine, CHU, Nancy, France.
Ahmet
A
Ayav
Department of Digestive Surgery and Transplantation, Hôpital Rangueil, Toulouse, France.
Bertrand
B
Suc
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
Olivier
O
Soubrane
Department of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland.
Gilles
G
Mentha
Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Irinel
I
Popescu
Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy.
Marco
M
Montorsi
Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Nicolas
N
Demartines
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
Jacques
J
Belghiti
Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy.
Guido
G
Torzilli
Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
Daniel
D
Cherqui
Department of Surgery, Hôpital de la Timone, Marseille, France.
Jean
J
Hardwigsen
D018248:Adenoma, Liver Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002471:Cell Transformation, Neoplastic; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden