Liver mass surgery: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 11: Line 11:
**Location
**Location
**Certainty of the diagnosis
**Certainty of the diagnosis
'''The following table summarizes surgical management of most common benign liver lesions that cause liver mass:'''<ref name="pmid16541615">{{cite journal |vauthors=Skalicky T, Treska V, Sutnar A, Liska V, Mirka H, Ohlidalova K, Ferda J |title=Surgical treatment of benign liver tumors |journal=Bratisl Lek Listy |volume=106 |issue=10 |pages=330–2 |year=2005 |pmid=16541615 |doi= |url=}}</ref><ref name="pmid28289336">{{cite journal |vauthors=Reddy KR |title=Benign Lesions of the Liver |journal=Gastroenterol Hepatol (N Y) |volume=2 |issue=5 |pages=325–326 |year=2006 |pmid=28289336 |pmc=5338186 |doi= |url=}}</ref><ref name="pmid23297727">{{cite journal |vauthors=Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR |title=Changes in the management of benign liver tumours: an analysis of 285 patients |journal=HPB (Oxford) |volume=15 |issue=2 |pages=156–63 |year=2013 |pmid=23297727 |pmc=3719923 |doi=10.1111/j.1477-2574.2012.00556.x |url=}}</ref><ref name="pmid17188079">{{cite journal |vauthors=Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF |title=Liver resection for benign liver tumors: indications and outcome |journal=Am. J. Surg. |volume=193 |issue=1 |pages=5–9 |year=2007 |pmid=17188079 |doi=10.1016/j.amjsurg.2006.04.017 |url=}}</ref><ref name="pmid9361515">{{cite journal |vauthors=Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R |title=Benign liver tumors: differential diagnosis and indications for surgery |journal=World J Surg |volume=21 |issue=9 |pages=983–90; discussion 990–1 |year=1997 |pmid=9361515 |doi= |url=}}</ref><ref name="pmid16541615">{{cite journal |vauthors=Skalicky T, Treska V, Sutnar A, Liska V, Mirka H, Ohlidalova K, Ferda J |title=Surgical treatment of benign liver tumors |journal=Bratisl Lek Listy |volume=106 |issue=10 |pages=330–2 |year=2005 |pmid=16541615 |doi= |url=}}</ref>
'''The following table summarizes surgical management of most common benign liver lesions that cause liver mass:'''<ref name="pmid16541615">{{cite journal |vauthors=Skalicky T, Treska V, Sutnar A, Liska V, Mirka H, Ohlidalova K, Ferda J |title=Surgical treatment of benign liver tumors |journal=Bratisl Lek Listy |volume=106 |issue=10 |pages=330–2 |year=2005 |pmid=16541615 |doi= |url=}}</ref><ref name="pmid28289336">{{cite journal |vauthors=Reddy KR |title=Benign Lesions of the Liver |journal=Gastroenterol Hepatol (N Y) |volume=2 |issue=5 |pages=325–326 |year=2006 |pmid=28289336 |pmc=5338186 |doi= |url=}}</ref><ref name="pmid23297727">{{cite journal |vauthors=Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR |title=Changes in the management of benign liver tumours: an analysis of 285 patients |journal=HPB (Oxford) |volume=15 |issue=2 |pages=156–63 |year=2013 |pmid=23297727 |pmc=3719923 |doi=10.1111/j.1477-2574.2012.00556.x |url=}}</ref><ref name="pmid17188079">{{cite journal |vauthors=Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF |title=Liver resection for benign liver tumors: indications and outcome |journal=Am. J. Surg. |volume=193 |issue=1 |pages=5–9 |year=2007 |pmid=17188079 |doi=10.1016/j.amjsurg.2006.04.017 |url=}}</ref><ref name="pmid9361515">{{cite journal |vauthors=Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R |title=Benign liver tumors: differential diagnosis and indications for surgery |journal=World J Surg |volume=21 |issue=9 |pages=983–90; discussion 990–1 |year=1997 |pmid=9361515 |doi= |url=}}</ref>
{| class="wikitable"
{| class="wikitable"
! rowspan="3" |
! rowspan="3" |

Revision as of 20:11, 6 February 2018

Liver Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Evaluation of Liver Mass

Staging

History and Symptoms

Physical Examination

Laboratory Studies

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Liver mass surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Liver mass surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Liver mass surgery

CDC on Liver mass surgery

Liver mass surgery in the news

Blogs on Liver mass surgery

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Liver mass surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Surgery

In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation. Surgery is the mainstay of treatment for benign liver lesions.

  • Management of lesions also depends upon:
    • Symptoms
    • Size
    • Number
    • Location
    • Certainty of the diagnosis

The following table summarizes surgical management of most common benign liver lesions that cause liver mass:[1][2][3][4][5]

Asymptomatic Symptomatic
Surgical Non-Surgical options
Indications Options
Hepatic adenoma The European Association for Study of the Liver recommends
  • Discontinuation of contraceptive medication
  • Close observation of the lesion with repeated imaging and alpha fetoprotein.
    • Contrast-enhanced MRI at a six 6 month interval to determine if there is regression.
  • Symptomatic patients
  • Large lesions (>5 cm).
  • Enucleation
  • Resection
  • Liver transplantation
  • Transarterial embolization
  • Radiofrequency ablation
Hepatic Hemangioma
  • Patients with lesions <1.5 cm
    • Reassurance
    • Observation
  • Patients with a rapid growth of a hemangioma or with lesions >5 cm
    • Repeat imaging in 6 to 12 months.
  • Abdominal pain
  • Symptoms suggestive of extrinsic compression of adjacent structures
  • Liver resection
  • Enucleation
  • Hepatic artery ligation
  • Liver transplantation
  • Hepatic artery embolization
  • Radiotherapy
  • Interferon alfa-2a 
Focal nodular hyperplasia
  • No indication for therapy unless they are symptomatic.
  • Follow-up imaging studies
    • 3-6 months will often be sufficient to confirm the stability of the lesion
  • N/A
  • N/A
  • N/A
Simple Hepatic cyst
  • No treatment
  • Cysts >4 cms in diameter
    • Periodic USG 3 months after initial diagnosis
    • 6-12 months follow up
    • If cyst remained stable no further treatment/followup
  • Abdominal pain
  • Growing cyst
  • Needle aspiration with or without injection of sclerosing agents
  • Internal drainage with cystojejunostomy
  • Wide unroofing/cyst resection
  • Liver resection 
Non-Invasive Cystadenoma
  • Surgery
    • High potential of malignant transformation
  • N/A
  • Removal of the cyst
    • Partial excision
    • Complete excision
  • Aspiration
  • Hepatic resection
    • Considered whenever a cystic lesion is suspected of containing invasive carcinoma
  • N/A
Invasive cystadenoma
  • N/A
  • N/A
  • Liver resection
  • Radiation
  • Chemotherapy
Hepatic abscess
  • N/A
  • Percutaneous
    •  Abscess size is more than 5 cm
  • Surgical drainage
    • Ruptured abscess
    • Hyperbilirubinemia or renal impairement
    • Multiple and loculated abscesses which cannot be easily accessible by percutaneous drainage
    • Inadequate drainage through percutaneous methods
  • ERCP
    • Bile duct stones 
    • Strictures
  • Percutaneous Drainage
  • Surgical Drainage
  • ERCP

References

  1. ↑ Skalicky T, Treska V, Sutnar A, Liska V, Mirka H, Ohlidalova K, Ferda J (2005). "Surgical treatment of benign liver tumors". Bratisl Lek Listy. 106 (10): 330–2. PMID 16541615.
  2. ↑ Reddy KR (2006). "Benign Lesions of the Liver". Gastroenterol Hepatol (N Y). 2 (5): 325–326. PMC 5338186. PMID 28289336.
  3. ↑ Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR (2013). "Changes in the management of benign liver tumours: an analysis of 285 patients". HPB (Oxford). 15 (2): 156–63. doi:10.1111/j.1477-2574.2012.00556.x. PMC 3719923. PMID 23297727.
  4. ↑ Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF (2007). "Liver resection for benign liver tumors: indications and outcome". Am. J. Surg. 193 (1): 5–9. doi:10.1016/j.amjsurg.2006.04.017. PMID 17188079.
  5. ↑ Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R (1997). "Benign liver tumors: differential diagnosis and indications for surgery". World J Surg. 21 (9): 983–90, discussion 990–1. PMID 9361515.
Retrieved from "https://www.wikidoc.org/index.php?title=Liver_mass_surgery&oldid=1440251"