Hepatic resection for benign non-cystic liver lesions

Hepatic resection is indicated for a variety of benign conditions because of persistent symptoms, uncertainty regarding the diagnosis or the risk of malignant transformation. The aim of this study was to assess the indications for and outcome of hepatic resection for benign non-cystic liver lesions in a specialist hepatobiliary unit.

All patients who had undergone hepatic resection for benign non-cystic hepatic lesions between 1989 and 2001 were identified from a prospective database for analysis.

A total of 49 patients (40 women, 9 men) with a mean age of 43 years (range 21-75 years) underwent resection of non-cystic benign lesions. Indications for operation included suspected liver cell adenoma (n=11), suspicion of malignancy (11), persistent symptoms attributable to the lesion (20) or chronic sepsis (7). The final diagnosis was focal nodular hyperplasia (n=12), haemangioma (12), adenoma (8), sclerosing cholangitis (5), inflammatory pseudotumour (4), intrahepatic cholelithiasis (3), chronic hepatic abscess (3), benign biliary fibrosis (I) and leiomyoma (I). Major anatomical hepatic resections were performed in 44 patients, and 5 patients underwent a segmentectomy or minor atypical resection. Median operating time was 215 min (range 45-450 min) and median blood loss was 875 ml (range 200-4000 ml). Ten patients (20%) required a median blood transfusion of 2 units (range 2-8 units). The median postoperative stay was 10 days (range 4-33 days). There were no deaths, but complications occurred in 15 patients (27%).

Hepatic resection can be safely recommended for selected patients with a variety of benign non-cystic hepatic lesions. A small group of patients undergo resection as a result of inability to rule out a malignant process, but the large majority will be operated on because of either their malignant potential or related symptoms.