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Multicenter Study
. 2020 Sep;40(9):2272-2278.
doi: 10.1111/liv.14467. Epub 2020 Apr 28.

A multicentre retrospective analysis on growth of residual hepatocellular adenoma after resection

Anne J Klompenhouwer  1 , Belle V van Rosmalen  2 , Martijn P D Haring  3 , Maarten G J Thomeer  4 , Michail Doukas  5 , Joanne Verheij  6 , Vincent E de Meijer  3 , Thomas M van Gulik  2 , Robert B Takkenberg  7 , Geert Kazemier  8 , Frederik Nevens  9 , Robert A de Man  10 , Jan N M Ijzermans  1
Affiliations
Multicenter Study

A multicentre retrospective analysis on growth of residual hepatocellular adenoma after resection

Anne J Klompenhouwer et al. Liver Int. 2020 Sep.

Abstract

Background & aims: Hepatocellular adenoma (HCA) is a benign liver tumour that may require resection in select cases. The aim of this study was to the assess growth of residual HCA in the remnant liver and to advise on an evidence-based management strategy.

Method: This multicentre retrospective cohort study included all patients with HCA who underwent surgery of HCA and had residual HCA in the remnant liver. Growth was defined as an increase of >20% in transverse diameter (RECIST criteria). Data on patient and HCA characteristics, diagnostic work-up, treatment and follow-up were documented and analysed.

Results: A total of 134 patients were included, one male. At diagnosis, median age was 38yrs (IQR 30.0-44.0) and median BMI was 29.9 kg/m2 (IQR 24.6-33.3). After resection, median number of residual sites of HCA was 3 (IQR 2-6). Follow-up of residual HCA showed regression in 24.6%, stable HCA in 61.9% and growth of at least one lesion in 11.2%. Three patients (2.2%) developed new HCA that were not visible on imaging prior to surgery. Four patients (3%, one male) underwent an intervention as growth was progressive. No statistically significant differences in clinical characteristics were found between patients with growing residual or new HCA versus those with stable or regressing residual HCA.

Conclusion: In patients with multiple HCA who undergo resection, growth of residual HCA is not uncommon but interventions are rarely needed as most lesions stabilize and do not show progressive growth. Surveillance is indicated when residual HCA show growth after resection, enabling intervention in case of progressive growth.

Keywords: adenoma liver cell; follow-up studies; surgical procedure.

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Conflict of interest statement

The authors do not have any disclosures to report.

Figures

FIGURE 1
FIGURE 1
Cases with growing residual HCA requiring intervention. HCA, hepatocellular adenoma; Preop, pre‐operative; Yr, number of years post‐operative; Mo, number of months post‐operative; OC, oral contraceptive; TAE, transarterial embolization. (A) Female patient with multiple residual HCA who underwent a re‐resection 12 and 14 years after the first resection because of progressively growing residual HCA. (B) Female patient with multiple residual HCA who underwent transarterial embolization and re‐resection 5 and 6 years after the first resection because of progressively growing residual HCA. (C) Female patient with single residual HCA who underwent transarterial embolization 5 years after resection because of progressively growing HCA. (D) Male patient with β‐catenin‐mutated HCA, who underwent radiofrequency ablation 6 months after resection because of one new HCA. Patient still has multiple new growing lesions and is currently on the waiting list for liver transplantation
FIGURE 2
FIGURE 2
Case demonstrating the effect of oral contraceptive on HCA. Female patient with single residual HCA that showed complete regression after resection. When OC was restarted, the lesion showed progressive growth. It regressed again after cessation of OC
See this image and copyright information in PMC

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