[Focal nodular hyperplasia and liver cell adenoma: operation or observation?]

In a 15-year period a total of 146 patients underwent surgery for benign hepatic tumors, including 54 focal nodular hyperplasias (FNH) and 23 hepatic cell adenomas (65 hemangioma and 4 cholangioma).

The medical records of these patients were retrospectively analyzed with respect to tumor-related symptoms, surgical procedures and postoperative complications.

Regardless of the type of the tumor, 70% of the patients had no or only non-specific symptoms. Most frequently, surgery was indicated due to questionable dignity of the lesion (adenoma 70%, FNH 41%). In hepatic cell adenomas (HCA) also perforation or bleeding of the tumor (17%) and severe symptoms (13%) required urgent operation. In two of three cases local excision of the lesion or segmental hepatic resection were performed, whereas extended resection procedures became necessary only in 20 (FNH) to 34% (HCA). The mean duration of postoperative intensive care treatment was significantly shorter in FNH and HCA than in other benign hepatic tumors (1.0 vs. 2.0 days, p < 0.01). After resection of FNH no fatalities or significant complications were observed. In HCA morbidity was 13% without related mortality (hemangioma: 3% mortality; 11% morbidity).

The elective resection of benign hepatic tumors can be achieved with very low mortality and morbidity, and usually provides longterm relief of annoying symptoms. Whenever HCA is suspected surgery should be performed, since severe symptoms and spontaneous hemorrhage (30%) are common in this tumor. Also hepatocellular carcinoma can be excluded only by histologic work-up of the operative specimen. In focal nodular hyperplasia (FNH), complications are rare and malignant transformation does not occur even when observation is employed only. Resection should be restricted to symptomatic or growing tumors with subsequent cholestasis or to cases with uncertain diagnosis.