José Manuel Ramia1, Carmen Bernardo2, Andrés Valdivieso3, Cristina Dopazo4, José María Jover5, M Teresa Albiol6, Fernando Pardo7, José Luis Fernandez Aguilar8, Alberto Gutierrez Calvo9, Alejandro Serrablo10, Luis Diez Valladares11, Fernando Pereira12, Luis Sabater13, Karim Muffak14, Joan Figueras6. 1. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España. Electronic address: jose_ramia@hotmail.com. 2. Sección Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Central de Asturias, Oviedo, España. 3. Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital de Cruces, Bilbao, España. 4. Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Vall d'Hebron, Barcelona, España. 5. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital de la Cruz Roja, Getafe, Madrid, España. 6. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Josep Trueta, Girona, España. 7. Unidad Hepatobiliopancreática, Servicio de Cirugía, Clínica Universitaria de Navarra, Pamplona, España. 8. Unidad Hepatobiliopancreática, Unidad de Gestión Clinica de Cirugía General, Digestiva y Trasplantes, Servicio de Cirugía, Hospital Carlos Haya, Málaga, España. 9. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España. 10. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Miguel Servet, Zaragoza, España. 11. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico San Carlos, Madrid, España. 12. Servicio de Cirugía, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España. 13. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico Universitario, Valencia, España. 14. Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Virgen de las Nieves, Granada, España.
Abstract
INTRODUCTION: Hepatic adenomas (HA) are benign tumours which can present serious complications, and as such, in the past all were resected. It has now been shown that those smaller than 3 cm not expressing β-catenin only result in complications in exceptional cases and therefore the therapeutic strategy has been changed. MATERIAL AND METHOD: Retrospective study in 14 HPB units. INCLUSION CRITERIA: patients with resected and histologically confirmed HA. STUDY PERIOD: 1995-2011. RESULTS: 81 patients underwent surgery. Age: 39.5 years (range: 14-75). Sex: female (75%). Consumption of oestrogen in women: 33%. Size: 8.8 cm (range, 1-20 cm). Only 6 HA (7.4%) were smaller than 3 cm. The HA median was 1 (range: 1-12). Nine patients had adenomatosis (>10HA). A total of 51% of patients displayed symptoms, the most frequent (77%) being abdominal pain. Eight patients (10%) began with acute abdomen due to rupture and/or haemorrhage. A total of 67% of the preoperative diagnoses were correct. Surgery was scheduled for 90% of patients. The techniques employed were: major hepatectomy (22%), minor hepatectomy (77%) and one liver transplantation. A total of 20% were performed laparoscopically. The morbidity rate was 28%. There were no cases of mortality. Three patients had malignisation (3.7%). The follow-up period was 43 months (range 1-192). Two recurrences were detected and resected. DISCUSSION: Patients with resected HA are normally women with large lesions and oestrogen consumption was lower than expected. Its correct preoperative diagnosis is acceptable (70%). The major hepatectomy rate is 25% and the laparoscopy rate is 20%. There was a low morbidity rate and no mortality.
INTRODUCTION:Hepatic adenomas (HA) are benign tumours which can present serious complications, and as such, in the past all were resected. It has now been shown that those smaller than 3 cm not expressing β-catenin only result in complications in exceptional cases and therefore the therapeutic strategy has been changed. MATERIAL AND METHOD: Retrospective study in 14 HPB units. INCLUSION CRITERIA: patients with resected and histologically confirmed HA. STUDY PERIOD: 1995-2011. RESULTS: 81 patients underwent surgery. Age: 39.5 years (range: 14-75). Sex: female (75%). Consumption of oestrogen in women: 33%. Size: 8.8 cm (range, 1-20 cm). Only 6 HA (7.4%) were smaller than 3 cm. The HA median was 1 (range: 1-12). Nine patients had adenomatosis (>10HA). A total of 51% of patients displayed symptoms, the most frequent (77%) being abdominal pain. Eight patients (10%) began with acute abdomen due to rupture and/or haemorrhage. A total of 67% of the preoperative diagnoses were correct. Surgery was scheduled for 90% of patients. The techniques employed were: major hepatectomy (22%), minor hepatectomy (77%) and one liver transplantation. A total of 20% were performed laparoscopically. The morbidity rate was 28%. There were no cases of mortality. Three patients had malignisation (3.7%). The follow-up period was 43 months (range 1-192). Two recurrences were detected and resected. DISCUSSION: Patients with resected HA are normally women with large lesions and oestrogen consumption was lower than expected. Its correct preoperative diagnosis is acceptable (70%). The major hepatectomy rate is 25% and the laparoscopy rate is 20%. There was a low morbidity rate and no mortality.