What is the surgical management of hepatic adenoma?

From the Guidelines

Liver adenoma surgery is recommended for adenomas larger than 5 cm, those that are growing, causing symptoms, or showing signs of malignant transformation, with the approach depending on tumor size, number, location, and surgical experience, as suggested by the EASL clinical practice guidelines 1. When considering liver adenoma surgery, several factors come into play, including the size and number of adenomas, their location within the liver, and the patient's overall health and surgical risk.

• The procedure can be performed through conventional open surgery or minimally invasive operations, such as laparoscopic or robotic surgery, depending on the specific circumstances of the case, as outlined in the management of hepatocellular carcinoma guidelines 1.
• Anatomic resection, which involves the systematic removal of the tumor-bearing portal territories, may be preferred in certain cases to ensure complete removal of the adenoma and potentially reduce the risk of recurrence.
• Before undergoing surgery, patients typically undergo comprehensive imaging studies, such as CT or MRI scans, and possibly a biopsy to confirm the diagnosis of liver adenoma and rule out other conditions, such as hepatocellular carcinoma.
• The surgery is usually performed under general anesthesia and may require a hospital stay of several days, followed by a recovery period that can range from a few weeks for laparoscopic procedures to several weeks for open surgery.
• It is particularly important for certain patient groups, such as men with liver adenomas or women whose adenomas do not regress after stopping hormonal contraceptives, to consider surgery due to their increased risk of malignant transformation.
• Potential complications of liver adenoma surgery include bleeding, infection, bile leakage, and liver dysfunction, but the liver's ability to regenerate often allows for good functional recovery, as noted in the context of hepatocellular carcinoma management 1.
• Regular follow-up with imaging studies is crucial after surgery to monitor for recurrence, especially in patients with underlying liver disease or genetic conditions that predispose them to the formation of liver adenomas.

From the Research

Liver Adenoma Surgery

• Surgical resection is generally indicated to reduce risks of hemorrhage and malignant transformation in patients with liver adenoma 2.
• The decision to perform surgery depends on various factors, including the size and location of the adenoma, as well as the patient's overall health and medical history 3, 4, 5, 6.
• Studies have shown that surgical resection can be safely performed using either an open or laparoscopic approach, with the choice of approach depending on the individual patient's circumstances 2, 5.
• The management of liver adenoma should be individualized, taking into account the size and mode of presentation of the adenoma, as well as the patient's risk factors for complications such as hemorrhage and malignant transformation 3, 4, 5, 6.

Indications for Surgery

• Surgical resection is recommended for patients with liver adenomas that are 5 cm or larger in diameter, due to the increased risk of complications such as hemorrhage and malignant transformation 3, 4, 5, 6.
• Male patients with liver adenoma are at higher risk of malignant transformation and should be considered for surgical resection regardless of the size of the adenoma 3, 4.
• Patients with a history of oral contraceptive use or other risk factors for liver adenoma should be carefully evaluated and considered for surgical resection if the adenoma is large or if there are other concerning features 2, 3, 5, 6.

Surgical Techniques

• Both open and laparoscopic surgical approaches can be used to resect liver adenomas, with the choice of approach depending on the individual patient's circumstances and the surgeon's preference 2, 5.
• Laparoscopic surgery may be a suitable option for patients with smaller adenomas or those who are at higher risk for complications with open surgery 2, 5.
• Transarterial embolization may be used as an initial treatment for liver adenomas that are complicated by hemorrhage 3, 6.