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HPB (Oxford). 2016 Sep;18(9):748-55. doi: 10.1016/j.hpb.2016.06.011. Epub 2016 Jul 22.

European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group.

Author information

1
Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France; INSERM, UMR 955, Créteil, France. Electronic address: alexis.laurent@aphp.fr.
2
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
3
Department of hepatology, Hôpital Jean Verdier, Bondy, France; Inserm, UMR-1162, Paris, France.
4
Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, Lille, France.
5
Department of Digestive Surgery and Transplantation, St Eloi Hospital, Montpellier, France.
6
Clinique d'Hépatogastroentérologie, pôle DigiDune, CHU de Grenoble, France.
7
Department of Surgery, University Hospital of Hautepierre, Strasbourg, France.
8
Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.
9
Department of Surgery, Hôpital de la Croix Rousse, Lyon, France.
10
Department of Surgery, Hôpital de la Timone, Marseille, France.
11
Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Université de Lorraine, CHU, Nancy, France.
12
Department of Digestive Surgery and Transplantation, Hôpital Rangueil, Toulouse, France.
13
Department of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland.
14
Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
15
Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy.
16
Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
17
Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
18
CHU, Amiens-Picardie, France.
19
CHU, Grenoble, France.
20
Hôpital de Jolimont, La Louvière, Belgium.
21
(CHUV), Lausanne, Switzerland.
22
CHRU, Lille, France.
23
CHU, Lyon, France.
24
CHU, Marseille, France.
25
Hôpital Saint-Joseph, Marseille, France.
26
Institut Paoli-Calmettes, Marseille, France.
27
CHU, Nimes, France.
28
CHU, Pitié-Salpétrière, Paris, France.
29
CHU, Poitier, France.
30
CHU, Reims, France.
31
CHU, St-Etienne, France.
32
CHU, Strasbourg, France.
33
CHU, Toulouse, France.

Abstract

BACKGROUND:

Hepatocellular adenoma (HCA) is a benign hepatic lesion that may be complicated by bleeding and malignant transformation. The aim of the present study is to report on large series of liver resections for HCA and assess the incidence of hemorrhage and malignant transformation.

METHODS:

A retrospective cross-sectional study, from 27 European high-volume HPB units.

RESULTS:

573 patients were analyzed. The female: male gender ratio was 8:2, mean age: 37 ± 10 years. Of the 84 (14%) patients whose initial presentation was hemorrhagic shock (Hemorrhagic HCAs), hemostatic intervention was urgently required in 25 (30%) patients. No patients died after intervention. Tumor size was >5 cm in 74% in hemorrhagic HCAs and 64% in non-hemorrhagic HCAs (p < 0.001). In non-hemorrhagic HCAs (n = 489), 5% presented with malignant transformation. Male status and tumor size >10 cm were the two predictive factors. Liver resections included major hepatectomy in 25% and a laparoscopic approach in 37% of the patients. In non-hemorrhagic HCAs, there was no mortality and major complications occurred in 9% of patients.

DISCUSSION:

Liver resection for HCA is safe. Presentation with hemorrhage was associated with larger tumor size. In males with a HCA >10 cm, a HCC should be suspected. In such situation, a preoperative biopsy is preferable and an oncological liver resection should be considered.

PMID:
27593592
PMCID:
PMC5011084
DOI:
10.1016/j.hpb.2016.06.011
[Indexed for MEDLINE]
Free PMC Article

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