Changes in the management of benign liver tumours: an analysis of 285 patients. Issue 2 (21st September 2012)

• Record Type: Journal Article
• Authors: Mezhir, James J.; Fourman, Lindsay T.; Do, Richard K.; Denton, Brian; Allen, Peter J.; D'Angelica, Michael I.; DeMatteo, Ronald P.; Fong, Yuman; Jarnagin, William R.
• Is Part Of: HPB. Volume 15:Issue 2(2013:Feb.)
• Page Start: 156
• Page End: 163
• Publication Date: 2012-09-21
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/j.1477-2574.2012.00556.x
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Objectives: Benign liver tumours (BLTs) are common and their management remains controversial. This study assesses the safety of a selective management approach. Methods: Patients with BLT were identified from an institutional database. Patients with simple cysts or an incidental BLT in the setting of metastasis or concomitant malignancy were excluded. Results: A total of 285 patients presenting during the period from January 1992 to December 2009 with haemangioma (53.0%), focal nodular hyperplasia (23.9%), adenoma (10.2%) or indeterminate/other lesions (13.0%) were evaluated. Of these, 117 patients (41.1%) underwent immediate resection and 168 patients (58.9%) were followed with serial imaging (median follow‐up: 30 months). During observation, eight patients (4.8%) underwent resection for tumour growth, inability to exclude malignancy or symptoms; no patients demonstrated malignant transformation or tumour‐related complications. During the study period, the number of BLTs evaluated and the proportion of patients observed increased from 129 BLTs of which 36.4% were observed in 1992–2002 to 156 BLTs of which 71.2% were observed in 2003–2009 ( P < 0.001). Diagnostic uncertainty led to resection in 29.5% of patients during the earlier period, but in only 13.4% during the more recent 7 years ( P < 0.05). Conclusions: Asymptomatic BLTs without concern for malignancy or adenoma can be safely observed with minimal risk for misdiagnosis. Patients selected for observation rarely require resection or develop tumour‐related complications.