What are the guidelines for managing liver cysts?

From the Guidelines

Symptomatic simple hepatic cysts without biliary communication should be treated with the best locally available volume-reducing therapy, such as percutaneous aspiration sclerotherapy or surgical deroofing (fenestration), as recommended by the most recent guidelines 1. The management of liver cysts depends on various factors, including the presence of symptoms, the underlying cause, and the type of cyst.

• Most simple liver cysts are asymptomatic and benign, and therefore, require no treatment.
• For symptomatic simple cysts causing pain, bloating, or early satiety, treatment options include percutaneous aspiration with sclerotherapy or surgical deroofing (fenestration) 1.
• Aspiration alone is not recommended due to high recurrence rates, as mere aspiration of cyst fluids invariably results in refilling of the cyst cavity with fluid 1.
• The available studies have a retrospective single centre design, and high-quality randomised-controlled trials that directly compare these volume-reducing therapies have not yet been published 1.
• Sclerotherapy is possible with multiple substances such as 100% ethanol, 20% saline, tetracycline or polidocanol without clear evidence for superiority of any of the agents 1.
• The volume reduction after aspiration sclerotherapy is slow in onset and may take at least 6 months, and therefore, reintervention in the first 6 months after aspiration sclerotherapy is not advised 1.
• Reported volume reductions after aspiration sclerotherapy range between 76-100%, while symptom relief is obtained in 72-100% of cases and symptom disappearance occurs in 56-100% 1.
• Laparoscopic and open cyst deroofing/fenestration are associated with a low (<8%) recurrence rate 1.
• For polycystic liver disease, treatment is reserved for symptomatic patients and may include cyst aspiration, surgical fenestration, or in severe cases, liver transplantation 1.
• The management approach is individualized based on cyst type, size, location, symptoms, and patient comorbidities, with the goal of relieving symptoms while minimizing procedural risks.
• Regular monitoring with ultrasound or CT imaging is recommended for asymptomatic cysts to detect any changes in size or characteristics 1.

From the Research

Guidelines for Managing Liver Cysts

The management of liver cysts depends on the size, symptoms, and type of cyst. The following are some guidelines for managing liver cysts:

• Symptomatic liver cysts can be managed surgically by fenestration or by hepatic resection 2.
• Laparoscopic fenestration is the best treatment for symptomatic liver cysts as the primary operation, associated with the lowest blood loss, lowest morbidity, and shortest hospital stay 2.
• Liver resection is best reserved for recurrent symptomatic cysts and cystic lesions suspicious of tumors where it can be safely performed and associated with a zero recurrence rate 2.

Comparison of Treatment Options

Different treatment options are available for liver cysts, including:

• Ablation therapy with sclerotic agents, which is effective but can have complications such as severe pain 3.
• Cyst unroofing, which is a surgical method that can be performed laparoscopically or openly, and is effective in managing simple liver cysts 3.
• Percutaneous sclerotherapy, which is a minimally invasive option that can be used to treat simple liver cysts and polycystic liver disease, but may have a higher recurrence rate 4.
• Percutaneous aspiration and ethanolamine oleate sclerotherapy, which is a minimally invasive option that has shown promising results in managing symptomatic polycystic liver disease 5.

Specific Considerations for Polycystic Liver Disease

Polycystic liver disease (PLD) is a condition characterized by the presence of multiple cysts in the liver. The management of PLD includes:

• Percutaneous sclerotherapy, which can be used to treat PLD, but may have a higher recurrence rate 4.
• Surgical treatment, which can be used to treat PLD, but may have a higher morbidity and mortality rate 4.
• Liver transplantation, which may be considered in patients with PLD and significant liver dysfunction 6.
• Medical therapies, such as somatostatin analogues, which are being investigated as a potential treatment for PLD 6.