The challenge of liver resection in benign solid liver tumors in modern times – in which cases should surgery be done?

Abstract

Background Due to improved diagnostical and therapeutical approaches, benign liver tumors represent a challenge in clinical management. We here report our experience with patients undergoing liver resection for benign liver tumors.

Methods 188 One hundred eighty-eight consecutive patients, who underwent surgery for solid benign liver tumors from 1992 – 2014, were analyzed retrospectively. The focus was on diagnostic pathways, indications for surgery, and perioperative and postoperative quality of life (QoL).

Results Of 188 patients, 100 had focal nodular hyperplasia (FNH) (53.2 %), 33 had hepatocellular adenoma (17.5 %), and 55 had hemangioma (29.3 %). In most patients, there was more than one 1 indication for liver resection, including tumor-associated symptoms (n = 82, 43.6 %), suspicion of malignancy (n = 104, 55.3 %), tumor disease in the medical history (n = 48, 25.5 %), or tumor enlargement (n = 27, 14.4 %). Serious complications (>grade III;, Clavien-Dindo) occurred in 9.5 % of patients. Perioperative mortality was 0.5 %. Patient pain scores decreased over time (p < 0.001). QoL after liver resection significantly improved (p = 0.007).

Conclusion Uncertainty of the tumor entity remains an issue in preoperative diagnostics. If indicated, liver resection for benign liver tumors represents a safe approach and leads to significant improvements of QoL.

Zusammenfassung

Hintergrund Trotz einer kontinuierlichen Verbesserung von diagnostischen und therapeutischen Verfahren, stellen gutartige Lebertumore eine Herausforderung im klinischen Behandlungssetting dar. So kann in einigen Fällen trotz mehreren unterschiedlichen diagnostischen Verfahren keine eindeutige Dignität des Tumors ermittelt werden. Wir berichten unsere Ergebnisse bei Patienten mit gutartigen Lebertumoren, welche eine Leberresektion erhalten haben.

Methodik 188 aufeinanderfolgende Patienten, bei denen zwischen 1992 und 2014 bei einem primär gutartigen Lebertumor eine Leberresektion durchgeführt worden war, wurden restrospektiv analysiert. Das Hauptaugenmerk lag hierbei auf der Analyse der diagnostischen Algorithmen, Indikationen zur Operation wie auch die Analyse der prä- und postoperativen Lebensqualität.

Ergebnisse Von diesen 188 operierten Patienten hatten 100 Patienten eine Fokal Noduläre Hyperplasie (FNH) (53,2 %), 33 Patienten ein Hepatozelluläres Adenom (HCA) (17,5 %) und 55 Patienten ein Hämangiom (29,3 %). Bei den meisten Patienten bestand mehr als eine Indikation für den operative Eingriff, darunter tumorassoziierte Beschwerden (n = 82; 43,6 %), der Verdacht auf Malignität bzw. eine Krebserkrankung in der Vorgeschichte (n = 104; 55,3 %/ n = 48; 25,5 %) oder eine Tumorvergrösserung mit Kompression von vaskulären und/oder biliären Strukturen (n = 27; 14,4 %). Schwerwiegende perioperative Komplikationen (> Grad III nach der Clavien-Dindo-Klassifikation) wurden in 9,5 % der Fälle beobachtet. Die 30-Tage Mortalität betrug 0,5 %.

Der subjective Schmerz-Score der Patienten nahm im Verlauf kontinuierlich ab (p < 0,001). Die Lebensqualität nach Leberresektion verbesserte sich signifikant (p = 0,007).

Zusammenfassung Eine nicht eindeutige Dignität des Tumors stellt nach wie vor eine Herausforderung in der präoperativen Diagnostik dar. Wenn indiziert, ist die Leberresektion bei gutartigen Lebertumoren ein sicheres und zuverlässiges Verfahren und führt zu einer signifikanten Verbesserung der postoperativen Lebensqualität.

Schlüsselwörter

Benigne Lebertumore - Leberresektion - Diagnostische Algorithmen - Lebensqualität

Key words

liver resection - quality of life - diagnostical algorithm - benign liver tumor

^* Both authors share first authorship and contributed equally to this work.

^** Both authors share senior authorship and contributed equally to this work.

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