Large size and haemorrhage are not contraindications to laparoscopic resection of hepatocellular adenoma

Background: Hepatocellular adenoma (HCA) is a hepatocyte derived neoplastic lesion with an increasing incidence and a strong association with oestrogen therapy. Laparoscopic resection has proven safe for small, non-ruptured lesions whilst its use for large adenomas (≥10 cm) and cases of haemorrhage requires further investigation.

Methods: All patients undergoing liver resection for HCA at the Royal Brisbane Hospital between January 2003 and April 2018 were analysed. Ethics approval was obtained.

Results: Thirty-three laparoscopic and three open resections were performed in 35 patients, all female, with a median age of 35 years (range 14-75). Nine laparoscopic resections were performed for large adenomas (≥10 cm) and 17 laparoscopic resections were performed for adenomas of intermediate size (5-9.9 cm). Only one conversion to open surgery was required for an intermediate sized tumour. Haemorrhage, either intratumoural, intraparenchymal or free intraperitoneal was the indication for resection in six of the 33 laparoscopic cases. Median operative time was 143 and 266 min for laparoscopically resected intermediate and large lesions, respectively. The median length of stay was 5 days (range 4-9) and no major complications were observed in the laparoscopic group. β-catenin mutation was seen in four of nine large adenomas whereas the inflammatory subtype constituted 11 of 17 intermediate sized lesions.

Conclusion: Laparoscopic surgery has been demonstrated to be safe for the resection of HCA in this group of patients. Importantly, haemorrhage and/or large size were not barriers to laparoscopic resection.