Hepatocellular adenoma surgery: Difference between revisions

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Latest revision as of 02:20, 23 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Zahir Ali Shaikh, MD [3]

Overview

Surgical resection is the treatment of choice for hepatocellular adenoma larger than 5 cm in diameter, the ones that increase in size, lesions with intra-tumoral hemorrhage, and male patients (irrespective of the adenoma size). Liver transplantation may be considered for hepatocellular adenomas associated with glycogen storage disease type 1. Radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered for patients who are poor candidates for surgery.

Surgery

Surgery is the treatment of choice for hepatocellular adenoma.^[1]^[2]^[3]
Elective surgical resection of hepatocellular adenoma is considered for all adenoma lesions with the following characteristics:^[4]^[5]
- Lesions > 5 cm in diameter
- Lesions that increase in size
- Lesions with intratumoral hemorrhage
- Male patients (irrespective of adenoma size)
Liver transplantation may be considered for hepatocellular adenoma associated with glycogen storage disease type 1.^[6]
In adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, and morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered.
Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepatocellular adenoma, hepatocellular carcinoma, and colorectal metastases as well.^[7]
Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hyper-vascular arterial lesions.

Approach to the Management of Hepatocellular Adenoma Based on Clinical Features, Gender, Imaging Features, and Histology:

MRI features of hepatic adenoma

Asymptomatic

Symptomatic

Male & glycogen storage disease

Female

Hemodynamically stable

Hemodynamically unstable

Resection irrespective of size & subtype

Stop offending drugs

Radiofrequency ablation resection

Embolization resection

< 5 cm

> 5 cm

Steatotic (HNF1 a) Hepatic adenoma

Inflammatory hepatic adenoma

Beta catenin hepatic adenoma

Others

Consider resection

Followup, genetic counselling for MODY & hepatic adenomatosis

Close followup, treatment of obesity

Biopsy & resection if confirmed

Biopsy & treat based on subtype

References

↑ Paulette Bioulac-Sage, Herve Laumonier, Gabrielle Couchy, Brigitte Le Bail, Antonio Sa Cunha, Anne Rullier, Christophe Laurent, Jean-Frederic Blanc, Gaelle Cubel, Herve Trillaud, Jessica Zucman-Rossi, Charles Balabaud & Jean Saric (2009). "Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience". Hepatology (Baltimore, Md.). 50 (2): 481–489. doi:10.1002/hep.22995. PMID 19585623. Unknown parameter |month= ignored (help)
↑ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text
↑ Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.
↑ T. Terkivatan, J. H. de Wilt, R. A. de Man, R. R. van Rijn, H. W. Tilanus & J. N. IJzermans (2001). "Treatment of ruptured hepatocellular adenoma". The British journal of surgery. 88 (2): 207–209. doi:10.1046/j.1365-2168.2001.01648.x. PMID 11167868. Unknown parameter |month= ignored (help)
↑ J. Belghiti, D. Pateron, Y. Panis, V. Vilgrain, J. F. Flejou, J. P. Benhamou & F. Fekete (1993). "Resection of presumed benign liver tumours". The British journal of surgery. 80 (3): 380–383. PMID 8472159. Unknown parameter |month= ignored (help)
↑ Jan P. Lerut, Olga Ciccarelli, Christine Sempoux, Etienne Danse, Jacques deFlandre, Yves Horsmans, Etienne Sokal & Jean-Bernard Otte (2003). "Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation". Transplant international : official journal of the European Society for Organ Transplantation. 16 (12): 879–884. doi:10.1007/s00147-003-0613-3. PMID 12904843. Unknown parameter |month= ignored (help)
↑ Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[1] Paulette Bioulac-Sage, Herve Laumonier, Gabrielle Couchy, Brigitte Le Bail, Antonio Sa Cunha, Anne Rullier, Christophe Laurent, Jean-Frederic Blanc, Gaelle Cubel, Herve Trillaud, Jessica Zucman-Rossi, Charles Balabaud & Jean Saric (2009). "Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience". Hepatology (Baltimore, Md.). 50 (2): 481–489. doi:10.1002/hep.22995. PMID 19585623. Unknown parameter |month= ignored (help)

[cde-2] Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text

[pmid8813164-3] Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.

[4] T. Terkivatan, J. H. de Wilt, R. A. de Man, R. R. van Rijn, H. W. Tilanus & J. N. IJzermans (2001). "Treatment of ruptured hepatocellular adenoma". The British journal of surgery. 88 (2): 207–209. doi:10.1046/j.1365-2168.2001.01648.x. PMID 11167868. Unknown parameter |month= ignored (help)

[5] J. Belghiti, D. Pateron, Y. Panis, V. Vilgrain, J. F. Flejou, J. P. Benhamou & F. Fekete (1993). "Resection of presumed benign liver tumours". The British journal of surgery. 80 (3): 380–383. PMID 8472159. Unknown parameter |month= ignored (help)

[6] Jan P. Lerut, Olga Ciccarelli, Christine Sempoux, Etienne Danse, Jacques deFlandre, Yves Horsmans, Etienne Sokal & Jean-Bernard Otte (2003). "Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation". Transplant international : official journal of the European Society for Organ Transplantation. 16 (12): 879–884. doi:10.1007/s00147-003-0613-3. PMID 12904843. Unknown parameter |month= ignored (help)

[7] Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter |month= ignored (help)

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@@ Line 3: / Line 3: @@
 {{CMG}}; {{AOEIC}} {{CZ}} {{ZAS}}
 ==Overview==
-There is no specific medical therapy for the hepatocellular adenomas. The wait and watch policy is recommended for hepatocellular adenoams <5cm following cessation of offending drugs (OCPs) and no further growth detected. Annual followup is scheduled with MRI or ultrasound until menopause.
+[[Surgical resection]] is the treatment of choice for hepatocellular adenoma larger than 5 cm in [[diameter]], the ones that increase in size, [[Lesion|lesions]] with intra-[[Tumor|tumoral]] [[hemorrhage]], and male [[Patient|patients]] (irrespective of the [[adenoma]] size). [[Liver transplantation]] may be considered for hepatocellular adenomas associated with [[Glycogen storage disease type I|glycogen storage disease type 1]]. [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] and [[Transcatheter arterial chemoembolization|transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) may be considered for [[Patient|patients]] who are poor candidates for [[surgery]].
-==Hepatocellular adenoma surgery==
+==Surgery==
-* There is no specific medical therapy for the hepatocellular adenoma.<ref name=cde>{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164  }} </ref>
+* [[Surgery]] is the treatment of choice for hepatocellular adenoma.<ref>{{Cite journal
-* Historically, hepatocellular adenomas were treated with a wait and watch policy, with surgical intervention recommended for larger (>5cm) tumors.
+ | author = [[Paulette Bioulac-Sage]], [[Herve Laumonier]], [[Gabrielle Couchy]], [[Brigitte Le Bail]], [[Antonio Sa Cunha]], [[Anne Rullier]], [[Christophe Laurent]], [[Jean-Frederic Blanc]], [[Gaelle Cubel]], [[Herve Trillaud]], [[Jessica Zucman-Rossi]], [[Charles Balabaud]] & [[Jean Saric]]
-* In asymptomatic female patients of hepatocellular adenomas , the first step is to stop the offending drug (OCPs) and check adenoma size on followup.
+ | title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience
-* The wait and watch policy is recommended when hepatocellular adenomas are <5cm or regress (to <5cm) following cessation of offending drug (OCPs) and no further growth detected.
+ | journal = [[Hepatology (Baltimore, Md.)]]
-* An yearly followup with MRI or ultrasound is scheduled for patients untill menopause.
+ | volume = 50
+ | issue = 2
+ | pages = 481–489
+ | year = 2009
+ | month = August
+ | doi = 10.1002/hep.22995
+ | pmid = 19585623
+}}</ref><ref name="cde">{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164  }} </ref>
+* Elective [[Surgery|surgical]] [[resection]] of hepatocellular adenoma is considered for all [[adenoma]] [[Lesion|lesions]] with the following characteristics:<ref>{{Cite journal
+ | author = [[T. Terkivatan]], [[J. H. de Wilt]], [[R. A. de Man]], [[R. R. van Rijn]], [[H. W. Tilanus]] & [[J. N. IJzermans]]
+ | title = Treatment of ruptured hepatocellular adenoma
+ | journal = [[The British journal of surgery]]
+ | volume = 88
+ | issue = 2
+ | pages = 207–209
+ | year = 2001
+ | month = February
+ | doi = 10.1046/j.1365-2168.2001.01648.x
+ | pmid = 11167868
+}}</ref><ref>{{Cite journal
+ | author = [[J. Belghiti]], [[D. Pateron]], [[Y. Panis]], [[V. Vilgrain]], [[J. F. Flejou]], [[J. P. Benhamou]] & [[F. Fekete]]
+ | title = Resection of presumed benign liver tumours
+ | journal = [[The British journal of surgery]]
+ | volume = 80
+ | issue = 3
+ | pages = 380–383
+ | year = 1993
+ | month = March
+ | pmid = 8472159
+}}</ref>
+**[[Lesion|Lesions]] > 5 cm in [[diameter]]
+**[[Lesion|Lesions]] that increase in size
+**[[Lesion|Lesions]] with [[Tumoral|intratumoral]] [[hemorrhage]]
+**Male patients (irrespective of [[adenoma]] size)
+* [[Liver transplantation]] may be considered for hepatocellular adenoma associated with [[Glycogen storage disease type I|glycogen storage disease type 1]].<ref>{{Cite journal
+ | author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]]
+ | title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation
+ | journal = [[Transplant international : official journal of the European Society for Organ Transplantation]]
+ | volume = 16
+ | issue = 12
+ | pages = 879–884
+ | year = 2003
+ | month = December
+ | doi = 10.1007/s00147-003-0613-3
+ | pmid = 12904843
+}}</ref>
+* In adenoma [[Patient|patients]] who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], and [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered.
+* [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a [[Minimally invasive procedure|minimally invasive technique]] that can be used for hepatocellular adenoma, [[hepatocellular carcinoma]], and [[colorectal]] [[Metastasis|metastases]] as well.<ref>{{Cite journal
+ | author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]]
+ | title = Hepatocellular adenoma: when and how to treat? Update of current evidence
+ | journal = [[Therapeutic advances in gastroenterology]]
+ | volume = 9
+ | issue = 6
+ | pages = 898–912
+ | year = 2016
+ | month = November
+ | doi = 10.1177/1756283X16663882
+ | pmid = 27803743
+}}</ref>
+* [[Transcatheter arterial chemoembolization|Transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) is used in [[adenoma]] [[Patient|patients]] with [[hemodynamic instability]] due to [[bleeding]] hyper-[[vascular]] [[Artery|arterial]] lesions.
+==== Approach to the Management of Hepatocellular Adenoma Based on Clinical Features, Gender, Imaging Features, and [[Histology]]: ====
 {{familytree/start}}
 {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=MRI features of hepatic adenoma }}
@@ Line 21: / Line 81: @@
 {{familytree | | | C01 | | | | | | C02 | | | C03 | | | | C04 | | | | |C01=Male & glycogen storage disease|C02=Female|C03=Hemodynamically stable|C04=Hemodynamically unstable }}
 {{familytree | | | |!| | | | | | | |!| | | | |!| | | | | |!| | | | | | }}
-{{familytree | | | D01 | | | | | | D02 | | | D03 | | | | D04 | | | | |D01=Resection irrespective of size & sybtype|D02=Stop offending drugs|D03=Radiofrequency ablation resection|D04=Embolization resection }}
+{{familytree | | | D01 | | | | | | D02 | | | D03 | | | | D04 | | | | |D01=Resection irrespective of size & subtype|D02=Stop offending drugs|D03=Radiofrequency ablation resection|D04=Embolization resection }}
+{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | |,|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | }}
-{{familytree | | | | | | | | E01 | | | | | | | | E02 | | | | | | | | |E01=<5cm|E02=>5cm }}
+{{familytree | | | | | | | | E01 | | | | | | | | E02 | | | | | | | | |E01=< 5 cm|E02=> 5 cm }}
 {{familytree | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | | |!| | | | | | | | | | | }}
 {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | | }}
-{{familytree | | F01 | | F02 | | F03 | | F04 | | F05 | | | | | | | | | | | | |F01=Steatotic (HNF1 a) Hepatic adenoma|F02=Inflammatory hepatic adenoma|F03=Beta catenin hepatic adenoma|F04=Otehrs|F05=Consider resection }}
+{{familytree | | F01 | | F02 | | F03 | | F04 | | F05 | | | | | | | | | | | | |F01=Steatotic (HNF1 a) Hepatic adenoma|F02=Inflammatory hepatic adenoma|F03=Beta catenin hepatic adenoma|F04=Others|F05=Consider resection }}
 {{familytree | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | |!| | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | |G01=Followup, genetic counselling for MODY & hepatic adenomatosis|G02=Close followup, treatment of obesity & discontinue obesity|G03=Biopsy & resection if confirmed|G04=Biopsy & treat based on subtype }}
+{{familytree | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | |G01=Followup, genetic counselling for MODY & hepatic adenomatosis|G02=Close followup, treatment of obesity|G03=Biopsy & resection if confirmed|G04=Biopsy & treat based on subtype }}
-{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
 {{familytree/end}}