Hepatic resection for incidentaloma

The study goal was to review a single-center experience in hepatic resection for patients who presented with incidental liver tumors. With recent advances in diagnostic imaging techniques, incidental finding of liver tumors, or “incidentalomas,” is increasing in asymptomatic and healthy individuals....

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2004-11, Vol.8 (7), p.785-793
Main Authors: Liu, Chi Leung, Fan, Sheung Tat, Lo, Chung Mau, Chan, See Ching, Tso, Wai Kuen, Ng, Irene O., Wong, John
Format: Article
Language:English
Subjects:
Cancer
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - surgery
Case-Control Studies
Cholangiocarcinoma - mortality
Cholangiocarcinoma - surgery
Female
Hemangioma - mortality
Hemangioma - surgery
Hepatectomy
Hepatic resection
hepatocellular carcinoma
Humans
Incidental Findings
Liver Diseases - mortality
Liver Diseases - surgery
Liver Neoplasms - mortality
Liver Neoplasms - surgery
liver tumors
Male
Medical imaging
Middle Aged
Mortality
Multivariate Analysis
Retrospective Studies
survival outcomes
Survival Rate
Time Factors
Tumors
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Summary:The study goal was to review a single-center experience in hepatic resection for patients who presented with incidental liver tumors. With recent advances in diagnostic imaging techniques, incidental finding of liver tumors, or “incidentalomas,” is increasing in asymptomatic and healthy individuals. However, little information is available in the literature regarding the underlying pathology and operative outcomes after hepatic resection. Between January 1989 and December 2002, 1011 patients underwent hepatic resection for liver tumors; of these patients, 107 (11%) were asymptomatic individuals who presented with incidentalomas. Incidentalomas were first detected on percutaneous ultrasonography (n = 83), computed tomography (n = 23), or magnetic resonance imaging (n = 1). Fifteen (14%) patients had preoperative aspiration for cytology or biopsy for histology, and the results correlated with the final pathology in 12 patients. Fifty-six (52%) patients underwent major hepatic resection with resection of three or more Coiunaud's segments. Median postoperative hospital stay was 8 days (range, 3–66 days). The operative mortality rate was 1%, and the operative morbidity rate was 21%. Histologic examination of the resected specimen revealed malignant liver tumors in 62 (58%) patients, including hepatocellular carcinoma (HCC) (n = 48), cholangiocarcinoma (n = 8), lymphoma (n = 2), cystadenocarcinoma (n = 2), carcinoid tumor (n = 1), and malignant fibrous histiocytoma (n = 1). Benign pathologies were found in 45 (42%) patients, including focal nodular hyperplasia (n = 17), hemangioma (n = 12), angiomyolipoma (n = 5), cirrhotic regenerative nodule (n = 4), hepatic adenoma (n = 2), and others (n = 5). On multivariate analysis, male sex, age of greater than 50 years, and tumor size of greater than 4 cm were the independent predictive factors for malignant diseases. On retrospective analysis, 48 patients with HCC who presented with incidentalomas had significantly better survival outcomes after hepatic resection than did 646 patients with HCC who presented otherwise during the same study period. Hepatic resection for patients with incidentalomas is associated with a low operative mortality and acceptable morbidity. The diagnosis of malignant disease, especially HCC, should be considered in male patients older than 50 years who present with large hepatic lesions.
ISSN:1091-255X
1873-4626
DOI:10.1016/j.gassur.2004.06.001