From the Guidelines
A cystectomy for a liver cyst is indicated when the cyst causes significant symptoms, complications, or diagnostic uncertainty, and should be considered for symptomatic simple hepatic cysts without biliary communication, using the best locally available volume-reducing therapy, as recommended by the EASL clinical practice guidelines 1. When considering a cystectomy for a liver cyst, it is essential to evaluate the symptoms, size, and location of the cyst, as well as the presence of any complications or diagnostic uncertainty.
- Symptomatic simple hepatic cysts without biliary communication should be treated with the best locally available volume-reducing therapy, which may include percutaneous aspiration sclerotherapy or cyst fenestration 1.
- Cyst fenestration, also called deroofing, can be considered in patients with superficial large cysts, and provides effective long-term reduction of cyst volume and symptomatic relief 1.
- The procedure typically involves unroofing (fenestration) of the cyst wall laparoscopically or through open surgery, rather than complete excision, as this allows for decompression while minimizing surgical risk.
- For polycystic liver disease, surgery is reserved for the most symptomatic dominant cysts rather than attempting to address all cysts, and the treatment choice should be guided by a decision-making flowchart that takes into account the severity of symptoms, the size and location of the cysts, and the presence of any complications or diagnostic uncertainty 1. The EASL clinical practice guidelines recommend using symptom severity questionnaires to assess polycystic liver disease-related symptoms and efficacy of treatment, and suggest that transplantation may be considered for massive polycystic liver disease, severely affecting quality of life or accompanied by recurrent complications 1.
From the Research
Indications for Cystectomy in Liver Cysts
- Symptomatic liver cysts that cause pain, discomfort, or compression of adjacent organs may require cystectomy 2, 3, 4, 5
- Large dominant or multifocal small cysts that cause symptoms due to rapid growth, secondary infection, intra-cystic bleeding, or compression of adjacent organs may require surgical intervention 4
- Cystadenomas, hydatid cysts, and other complex cystic lesions may require cystectomy or pericystectomy 3, 6
Types of Liver Cysts that May Require Cystectomy
- Simple liver cysts that are symptomatic or complicated may require unroofing or cystectomy 3, 4, 5
- Hydatid cysts may require simple cystectomy or pericystectomy 3, 6
- Cystadenomas and other neoplastic cysts may require cystectomy or laparoscopic hepatectomy 3, 6
Minimally Invasive Approaches for Cystectomy
- Laparoscopic fenestration and laparoscopic hepatectomy are minimally invasive approaches that can be used for cystectomy 6, 5
- Percutaneous drainage and laparoscopic fenestration are commonly used for simple cysts and polycystic liver disease 6
- Laparoscopic hepatectomy is commonly used for polycystic liver disease, hydatid cysts, and cystadenomas 6