Surgical management of simple liver cysts

To date there is no consensus about the treatment of choice for symptomatic or complicated simple liver cysts.

A retrospective study of all patients diagnosed with simple liver cyst surgically managed at Ramon y Cajal Hospital during the period between 1998 and 2008 was performed.

We analyzed 21 patients, 18 females (85.7%) and three males (14.3%) with a mean age of 64.2 years. Ten patients (47.6%) were asymptomatic. During follow-up, cyst growth was determined. Three patients (14.3%) presented an infected simple liver cyst. Seven patients (33.3%) presented abdominal pain and one patient (4.8%) reported an abdominal mass during self-examination. Treatment consisted of unroofing and cyst drainage in 18 patients (85.7%) and cyst enucleation in three patients (14.3%). Postoperative complications appeared in two patients (9.6%). There was no mortality. Pathology revealed simple liver cyst in 17 patients (80.9%) and liver cystadenoma in four (19.1%). The latter were reoperated for complete cyst resection. Recurrence rate was 23.5% (four cases) for the simple liver cysts. In all cases, unroofing was performed.

In some cases, cystadenomas show ultrasonographic and radiological features similar to simple liver cysts, implying an incorrect surgical approach. We recommend performing an intraoperative biopsy of all resected liver cysts to confirm its nature. Unroofing is associated with a high recurrence rate (>20%). Therefore, we propose cyst enucleation as the best surgical treatment.