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 25 February 2018

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Management of large hepatic cystic lesions in adults

Research in July's Journal of the American College of Surgeons reports on the occurrence and management of large cystic lesions of the liver

News image

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Researchers from Miami, Florida, USA, performed a retrospective review of adults diagnosed with large hepatic cystic lesions, over a 15-year period.

78 patients with lesions greater than 4 cm were identified at a single institution. Those with polycystic disease and abscesses were not included.

The lesions were classified as simple cysts (n = 57), hepatobiliary cystadenomas (n = 8), echinococcal cysts (n = 8), or hepatobiliary cystadenocarcinoma (n = 1). The precise diagnosis could not be ascertained in 4 patients.

The mean size of the lesions was 12.1 cm (range, 4 to 30 cm). Simple cysts were found to be 6 times more prevalent in women.

Percutaneous aspiration of 28 simple cysts resulted in recurrence in 100% of the cases, within 3 weeks to 9 months.

48 patients were treated surgically by wide unroofing or resection (laparoscopically in 18). This resulted in low recurrence rates (11% for laparoscopy and 13% for open unroofing).

4 of the 8 patients with echinococcal cysts were symptomatic. All were treated by open resection, after irrigation of the cavity with hypertonic saline. The researchers found that there was no recurrence during a follow-up period of 2 to 14 years.

Appropriate management of lesions:
Simple cysts:
laparoscopic unroofing
Echinococcal cysts:
open resection
Hepatobiliary cystadenomas:
open resection
Journal of the American College of Surgeons

Hepatobiliary cystadenomas occurred more commonly in women (female:male, 7:1) and in the left hepatic lobe (left:right, 8:0). 7 of the 8 were found to be multiloculated. All were treated by open resection, with no recurrence, and none had malignant changes.

Cystadenocarcinoma was diagnosed in a 77-year-old man, and was treated by left hepatic lobectomy.

Dr Arie Regev, of the Center for Liver Diseases, Miami, said on behalf of fellow authors, "Large symptomatic simple cysts invariably recur after percutaneous aspiration. However, laparoscopic unroofing can be successfully undertaken, with a low recurrence rate.

"Open resection, after irrigation with hypertonic saline, is a safe and effective treatment for echinococcal cysts."

"Hepatobiliary cystadenomas have predilection for women and for the left hepatic lobe. Malignant transformation is an uncommon, but real, risk.

"Open resection is a safe and effective treatment for these type of lesions, and is associated with a low recurrence rate," it was concluded.

J Am Coll Surg 2001; 193 (1): 36-45
04 July 2001

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