What is the treatment for hepatic (liver) cysts?

From the Guidelines

Symptomatic simple hepatic cysts should be treated with the best locally available volume-reducing therapy, which can include percutaneous aspiration sclerotherapy or cyst fenestration, as these methods have been shown to provide significant symptom relief and volume reduction 1. The treatment approach for hepatic cysts depends on the presence of symptoms and the type of cyst.

Key Considerations

• For symptomatic simple hepatic cysts, volume-reducing therapies such as percutaneous aspiration sclerotherapy or cyst fenestration are recommended 1.
• Percutaneous aspiration sclerotherapy involves draining the cyst and then using a sclerosing agent to reduce the cyst's volume, with reported volume reductions ranging from 76-100% and symptom relief in 72-100% of cases 1.
• Cyst fenestration, which can be performed laparoscopically, involves removing part of the cyst wall to prevent fluid reaccumulation and has been associated with a low recurrence rate of less than 8% 1.
• Aspiration of cyst fluid without subsequent sclerotherapy is not recommended as definitive treatment due to the high likelihood of cyst refilling 1.
• The choice between percutaneous aspiration sclerotherapy and cyst fenestration should be based on the best locally available option, as high-quality randomized controlled trials comparing these therapies are not yet available 1.

Additional Treatment Options

• For polycystic liver disease, treatment may include percutaneous aspiration with sclerotherapy, though recurrence is common, and medications like somatostatin analogs may help slow cyst growth 1.
• Severe cases of hepatic cysts might require liver resection or even transplantation.
• Hydatid cysts, caused by Echinococcus, require specific treatment with antiparasitic medications like albendazole, often combined with surgical removal.
• Regular monitoring with ultrasound or CT scans is recommended for asymptomatic cysts to track growth, and patients should seek immediate medical attention if they experience sudden severe abdominal pain, fever, or jaundice, which could indicate complications like infection, rupture, or bile duct obstruction.

From the FDA Drug Label

Albendazole tablets are indicated for the treatment of cystic hydatid disease of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm, Echinococcus granulosus. The treatment for hepatic (liver) cysts, specifically cystic hydatid disease, is albendazole.

• The dosage is as follows:
  • Patients weighing 60 kg or greater: 400 mg twice daily
  • Patients weighing less than 60 kg: 15 mg/kg/day in divided doses twice daily (maximum total daily dose 800 mg)
• The treatment cycle for hydatid disease is a 28-day cycle followed by a 14-day albendazole-free interval, for a total of 3 cycles 2, 2.
• Patients should be monitored for safety, including blood counts and liver enzymes, during treatment 2, 2.

From the Research

Treatment Options for Hepatic Cysts

• Surgical management of symptomatic liver cysts can be achieved through fenestration or hepatic resection 3
• Laparoscopic fenestration is considered the best treatment for symptomatic liver cysts as the primary operation, associated with the lowest blood loss, lowest morbidity, and shortest hospital stay 3
• 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 3
• Single incision laparoscopic surgery (SILS) can be used to treat huge liver cysts with chronic heart failure and thrombosis of the inferior vena cava 4
• Unroofing and cyst drainage are common treatments for simple liver cysts, but unroofing is associated with a high recurrence rate (>20%) 5
• Cyst enucleation is proposed as the best surgical treatment for simple liver cysts due to its lower recurrence rate 5
• Laparoscopic treatment of liver cysts involves excising the exposed portion of the cyst wall and securing a piece of omentum into the remaining cyst cavity to prevent recurrence 6
• Asymptomatic simple cysts in the liver require no treatment, while therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing 7

Considerations for Treatment

• The choice of treatment depends on the type of cyst, symptoms, and patient's overall health 7
• Polycystic liver disease presents a unique management problem due to high morbidity and mortality rates from intervention and high rates of recurrence 7
• Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment 7
• Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery) 7
• Liver abscesses can effectively be treated by aspiration or drainage, and prolonged treatment with antibiotics may also be considered 7