2001, Number 3
PDF size: 205.82 Kb.
ABSTRACTAims: To evaluate indications and results of surgical management of benign liver tumours (BLT). Introduction: Liver resection remains the best way to treat BLT. The morbidity and mortality of this procedure in recent years in experienced centres have improved. Patients and method: A retrospective review of the clinical files of patients with BLT who were operated between May 1995 to December 1999 were reviewed. Results: There were 15 women and two men varying in age from 32 to 68 years with an average age of 45 years. Eleven had giant cavernomatous hemangiomas, two were liver adenomas, two focal nodular hiperplasia, one angiomiolipoma and one biliary adenofibroma. Twelve patients presented symptoms (70%), three were misdiagnosed as malignant, one presented accelerated growth, and one was operated on due to its nature. The lesions varied in size from 3 to 19 cm in diameter. Ten minor resections were performed that included five resections of the left lateral segment, three enucleations, two segmentectomies. There were seven major resections (five right and one left hepatectomy, and one left trisegmentectomy). Intraoperative bleeding ranged from 100 to 3,000 mL (mean, 1,200 mL). There were no surgical deaths. Two patients had postoperative complications (11.7%). Symptoms were relieved in all patients in follow-up. Conclusions: The results of our experience confirm that resection of benign liver tumours in a well-selected group of patients is a safe, radical curative procedure.
Iwatsuki S, Todo S, Starzl TE. Excisional therapy for benign hepatic lesions. Surg Gynecol Obstet 1990; 171: 240-246.
Ishak KG. Robin L. Benign tumours of the liver. Med Clin North Am 1975; 59: 995-1013.
Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg 1970; 172: 239-245.
Ackerman LV, Rosai J. Surgical pathology. 5th ed. St. Louis, MO, USA: Co; 1974.
Mathieu D, Kobeiter H, Cherqui D et al. Oral contraceptive intake in women with focal nodular hiperplasia of the liver. Lancet 1998; 352: 1679-1680.
Mondragón-Sánchez R, Bernal-Maldonado R, Oñate-Ocaña LF, Ruiz-Molina JM, Meseses-García A. Open versus laparoscopic fenestration or resection for the management of benign cystic liver lesions. J Am Coll Surg. In press.
Couniaud C. Lobes et segments hepatiques: note sur l’architecture anatomique et chirurgicale du foie. Press Med 1954; 63: 709.
Belli L, De Carlis L, Beati C, Rondinara G. Surgical treatment of symptomatic giant hemangiomas of the liver. Surg Gynecol Obstetr 1992; 174: 474-478.
Schwartz IS, Husser CW. Cavernous hemangioma of the liver. Ann Surg 1987; 205: 456-465.
Moreno-Egea A, Del Pozo-Rodríguez M, Cantero Vicente M, Atenza-Abellan J. Indications for surgery in the treatment of hepatic hemangioma. Hepato-Gastroenterol 1996; 43: 422-6.
Park WC, Phillips R. The role of radiation therapy in the management of hemangiomas of the liver. JAMA 1970; 212: 1496-1498.
Issa P. Cavernous large hemangiomas of the liver. N Engl J Med 1955; 252: 854-855.
Trastek VF, van Heerden JA, Sheedy PF, Adson MA. Cavernous hemangioma of the liver: resect or observe? Am J Surg 1983; 145: 49.
Farges O, Daradkeh S, Bismuth H. Cavernous hemangioma of the liver: are there any indications for resection? World J Surg 1995; 19: 19-24.
Grieco MB, Miscall BG. Giant hemangiomas of the liver. Surg Gynecol Obstet 1978; 147: 783.
Starzl TE, Koep LJ, Weil R et al. Excisional treatment of cavernous hemangioma of the liver. Ann Surg 1980; 192: 25.
Johnson CM, Sheedy PF, Stanson AW et al. Computed tomography and angiography of cavernous hemangiomas of the liver. Radiology 138: 115-121.
Wernecke K, Vassallo P, Bick U et al. The distinction between benign and malignant liver tumours on sonography. AJR 1992; 159: 1005-1009.
Semelka RC, Shoenut JP, Kroeker MA et al. Focal liver disease: comparison of dynamic contrast-enhanced CT and T2-weighted fat-suppressed, FLASH, and dynamic gadolinium-enhanced MR imaging at 1.5 T. Radiology 1992; 184: 687-94.
Craig JR, Peters RL and Edmonson HA. Atlas of tumour pathology, Washington, D.C.USA: Armed Forces Institute of Pathology; 1988.
Jenkins RL, Johnson LB, Lewis W.D. Surgical approach to benign liver tumours. Semin Liv Dis 1994; 14: 178-182.
Brady MS, Coit DG. Focal nodular hyperplasia of the liver. Surg Gynecol Obsetr 1990; 171: 377-380.
Edoute Y, Tibon-Fisher O, Ben Haim S, Malberger E. Ultrasonically guided fine-needle aspirations of liver lesions. Am J Gastroenterol 1992; 87: 1138-1141.
Gedaly R, Pomposelli J, Pomfret E et al. Cavernous hemangioma of the liver: anatomic resection vs enucleation. Arch Surg 1999; 134: 407-411.
Kuo PC, Lewis WD, Jenkins RL. Treatment of giant hemangiomas of the liver by enucleation. J Am Coll Surg 1994; 178: 49-53.
Baer HU, Dennison AR, Mouton W et al. Enucleation of giant hemangiomas of the liver. Ann Surg 1992; 216: 673-76.
Tepetes K, Selby R, Webb M, Madariaga JR. Orthotopic liver transplantation for benign hepatic neoplasms. Arch Surg 1995; 130: 153-156.