Title
Outcomes of liver resection for hepatocellular adenoma and focal nodular hyperplasia; results of
a prospective trial.
Authors
M. Bieze, M.D. 1
Youssef El-Massoudi, M.D. 1
J. Verheij, M.D. PhD 2
S.S.K.S. Phoa, M.D. PhD 3
O.R.C. Busch, M.D. PhD 1
D.J. Gouma, M.D. PhD 1
T.M. van Gulik, M.D. PhD 1
Affiliations
1
Department of Surgery, Academic Medical Center, the Netherlands
2
Department of Pathology, Academic Medical Center, the Netherlands
3
Department of Radiology, Academic Medical Center, the Netherlands
Contact information of the first and corresponding author:
Mw. Drs. M. Bieze, MD research fellow
Academic Medical Center
IWO 1-A1-132, Meibergdreef 9
1105 AZ Amsterdam, the Netherlands
Tel:
+31 20 5666653
Fax:
+31 20 6976621
E-mail: M.Bieze@amc.uva.nl
Abstract
Background
HCA and FNH are rare, benign liver lesions of which diagnosis and management generate
confusion. Resection for HCA >5cm is recommended because of risk of bleeding and malignant
transformation, whereas FNH is only resected because of symptoms. The aim of this study was to
assess selection for and outcome of resection of lesions suspicious of hepatocellular adenoma
(HCA) or focal nodular hyperplasia (FNH).
Methods
Between January 2008 and July 2011, 111 consecutive patients with suspicion on FNH or HCA
>2cm based on imaging studies were included. All patients underwent pre-operative Gd-EOBDTPA magnetic resonance (MR) imaging. Liver resections were classified as major: >3
segments, or minor: <3 segments, including laparoscopic and local excisions. Histological
diagnosis was used as standard of reference. Abdominal symptoms, postoperative morbidity
(Dindo/Clavien classification), mortality, and relief of symptoms were scored.
Results
In all 111 patients (4 male, 107 female; mean age 38years), the following preoperative diagnoses
were made after MR imaging: HCA (n=44), FNH (n=59), HCA+FNH (n=4), and 4 other
diagnoses. 46 patients were selected for resection because of diagnosis HCA>5cm (n=29),
symptomatic FNH, or strong wish of the patient (n=15). Mean lesion size was 7,9 cm (SD 2,5;
2,5-25 cm). 28/46 patients presented with complaints. Types of resection included 36 (78%)
minor (including 9 laparoscopic resections), and 10 major resections. Overall, the following
postoperative complications were recorded: Grade I: 7, Grade II: 4, Grade IIIa: 2, Grade IIIb: 1,
Grade IVa: 1. There was no mortality. Preoperative diagnosis was confirmed microscopically in
28/29 (97%) patients with HCA (1 hemangioma), and 15/15 (100%) patients with FNH. 26
(90%) patients with symptoms showed improved scores 3 months postoperatively.
Conclusions
Patients with suspicion on HCA or FNH were accurately diagnosed and selected for resection on
the basis of MR imaging and symptoms. Most lesions (78%) required minor resection with relief
of complaints in most patients (90%) with symptoms.