Elective Regional Therapy Treatment for Hepatic Adenoma

Locoregional therapy treatments for hepatic adenoma (HA) are typically limited to selective hepatic arterial embolization (HAE) to control acute hemorrhage. This systematic review sought to report the utilization of HAE and ablation for non-emergent treatment of HA.

A PubMed query identified studies reporting ablation or embolization for HA patients. Abstracts were screened to exclude studies with only patients managed for acute hemorrhage. Outcomes of interest included rate of success, complications, and repeat procedures.

Of 209 initial search results, 33 full-text publications were reviewed, and 10 were selected after applying the exclusion criteria. All were published from 2005 to 2016. A total of 105 patients were included, of which 66 patients with 138 adenomas underwent elective locoregional therapy treatment. The mean size of treated adenomas was 2.9 (range 0.8-8.3) cm. HAE was utilized in 25 patients with 58 adenomas, whereas 35 patients with 68 adenomas underwent radiofrequency ablation. Six patients with 12 adenomas received microwave ablation. Most patients were female (89/105), and adenomas were associated with oral contraceptive use or hormonal therapies in 49 of 105 patients. Success was reported in 115 of 138 first-time procedures, and repeat procedures were needed after 18 of 138. Mean follow-up time was 36.4 months, with two complications.

Reports of elective locoregional therapy for the treatment of HA are limited to case reports and small institutional series. In the select patients treated, outcomes are acceptable, with low rates of repeat procedures or complications. This systematic review warrants further discussion and broader consideration for the treatment of HA.