ORIGINAL ARTICLES   

Minerva Chirurgica 2010 October;65(5):495-506

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Liver resection for cystic lesions: a 15-year experience

Chouillard E., Gumbs A., Fangio P., Torcivia A., Tayar C., Laurent A., Dache A., Lacherade J. C., Tran Van Nhieu J., Cherqui D. ✉

¹ Department of General Surgery, Hospital Center of Poissy, Poissy, France 2 Department of Hepatobilairy and Pancreatic Surgery, Fox Chase Cancer Center Philadelphia, PA, USA 3 Department of Critical Care Medicine, Hospital Center of Poissy, Poissy, France 4 Department of Hepatobiliary and Digestive Surgery, Henri Mondor Hospital, Paris XII University, Créteil, France

AIM: The aim pf this paper was to review the management strategies in patients who had hepatic resection for cystic lesions. If symptomatic, a simple liver cyst (SC) is best treated by unroofing. A hydatid cyst (HC) is treated by simple cystectomy or pericystectomy. Many procedures have been described for the management of complex non-HCS including aspiration, sclerosing therapy, drainage, unroofing, and resection.
METHODS: A retrospective review of patients who had liver resection for cystic lesions between January 1, 1992, and December 31, 2006. The study was carried out at a University Hospital and a General Community Hospital affiliated with a University program. Management strategies were detailed, including clinical, biological, and imaging features. Operative morbidity and mortality as well as long-term outcome were also assessed. A comparison between preoperative and postoperative diagnoses was performed.
RESULTS: Thirty-three patients (24 women and 9 men) underwent 39 liver resections, including 14 left lateral resections, 12 right hemi-hepatectomies, 7 left hemi-hepatectomies and 6 segmentectomies or wedge resections. The final diagnosis included hydatid cyst in 10 patients (30%), cystadenoma in 6 (18%), simple cysts in 6 (18%), Caroli’s disease in 4 (12%), cystadenocarcinoma in 3 (9%) and miscellaneous in the 4 remaining (12%). There was no mortality and the postoperative morbidity rate was 15%. Long-term follow-up revealed that, besides patients with malignancies whose outcome was dismal, overall prognosis was positive with efficacious symptom control.
CONCLUSION; Accurate preoperative diagnosis of liver cystic lesions may be difficult. However, liver resection for such lesions is a safe procedure that provides long-term symptomatic control in benign disease and may be curative in cases of underlying malignancy. Even if nearly 50% of liver cystic lesions treated by resection were either symptomatic SC or HC, we recommend en-bloc liver resection for all liver cystic lesions that are not clearly parasitic or simple cysts.