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Hepatic adenoma regression after bariatric surgery: a case series and systematic review
Ian C Garbarine1, Amanda K Walsh1, Timothy M Pawlik2
1Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10 Ave, N943 Doan Hall, Columbus, OH, 43210, USA.
Background:
Hepatic adenomas (HA) are benign neoplasms of the liver that have small risks of hemorrhage and malignant transformation. While the association between obesity and the development of HAs is increasingly recognized, the impact of bariatric surgery on HA regression is poorly understood.
Methods:
All patients with a pre-operative diagnosis of HA who underwent primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single quaternary academic medical center from 2012 to 2024 were retrospectively queried and combined with all previously reported cases obtained via a systematic review of the literature. Patient clinical characteristics, including pre-operative and post-operative body mass index (BMI) and HA size, were extracted. Kendall's Tau-b correlation and fractional probit regression were used to assess the relationship between weight loss and HA size change.
Results:
The institutional review identified three patients, and the systematic review yielded five studies totaling seven patients. In the combined cohort (mean age 34.8 years), the average pre-operative BMI was 44.48 kg/m2 and decreased to 32.19 kg/m2 post-operatively, representing 68.18% excess weight loss (%EWL). Mean HA size decreased from 4.49 cm to 1.55 cm (56.46% reduction, SD 43.68), with 40% of patients experiencing complete regression. %EWL was significantly associated with HA size reduction (Kendall's Tau-b: 0.5528; p = 0.047). Marginal effects following fractional probit regression analysis showed that each additional percentage increase in %EWL was associated with 0.76% HA size reduction (95% CI: -1.18, -0.34; p < 0.001).
Conclusions:
In this combined case series and systematic review of the literature, bariatric surgery was associated with high rates of HA regression. Given the additional benefits of weight loss from bariatric surgery and the significant morbidity associated with liver resection, bariatric surgery could be considered as an initial management option for obese patients with HA.
