Indications and long-term outcome of treatment for benign hepatic tumors - A critical appraisal

Hypothesis: The natural history and clinical behavior of benign hepatic tumors during long-term follow-up may not justify primary surgical treatment. Design: Retrospective study. Setting: Tertiary referral center. Patients: Two hundred eight patients diagnosed as having a benign liver tumor between January 1, 1979, and December 31, 1999. Intervention: Seventy-four patients underwent hepatic surgery and 134 were managed conservatively by radiological follow-up. Main Outcome Measures: Symptoms and complications were assessed during management and follow-up. Results: In the surgically treated population, the liver lesion was symptomatic in 47 patients (64%) and an incidental finding in 27 (36%). The operative morbidity and mortality were 27% (20 of 74 patients) and 3% (2 of 74 patients), respectively. Overall, 28 (80%) of 35 patients with complaints were asymptomatic after surgery. During observation of the tumor in the conservatively managed group, 39 (87%) of 45 patients who presented with complaints were asymptomatic during a mean follow-up of 45 months; 6 patients had mild abdominal pain considered to be unrelated to the tumor. Conclusions: Conservative management of solid benign liver lesions such as focal nodular hyperplasia and hemangioma can be performed safely, irrespective of their size. We only advise surgery for liver lesions when there is an inability to exclude malignancy or in the case of severe complaints related to the tumor. Resection is always advocated in the case of a large hepatocellular adenoma (>5 cm) to reduce the risk of rupture and malignant degeneration.