Treatment Strategy in Non-Parasitic Benign Cysts of the Liver

Czech version

Authors: V. Liška; V. Třeška; H. Mírka ¹; T. Skalický; A. Sutnar; J. Ferda ¹
Authors‘ workplace: Chirurgická klinika, FN Plzeň-Lochotín, LF UK v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc. ; Radiodiagnostická klinika, FN Plzeň-Lochotín, LF UK v Plzni, přednosta: doc. MUDr. Boris Kreuzberg, CSc. ¹
Published in: Rozhl. Chir., 2008, roč. 87, č. 10, s. 512-516.
Category: Monothematic special - Original

Overview

The authors present the problems of treatment of benign non-parasitic cystic liver diseases. Recent diagnostic and treatment strategy is demonstrated at the cohort of 25 patients (16 women and 9 men), who were operated on Department of Surgery, Medical School and Teaching Hospital Pilsen, Charles University Prague between years 2002-2007. The average age was 59.9 years (38–86 years). We performed 15 laparoscopic fenestrations, 5 opened fenestrations, three enucleations of cysts and one left lobectomy and one central liver resection. The resections were performed because of diagnostic uncertainty to verify histological character of leasions at patients after previous operation of gastrointestinal tract for malignancy. Histological diagnosis was proved in 16 cases solitary liver cyst, in 7 cases of polycystic liver disease, one biliary cystadenoma and one retentive cyst. The reoperation of symptomatic solitary liver cyst was performed in one patient after 12 months from primary operation. The average follow-up of patients after surgical treatment was 41 months (5–96 months).

Solitary liver cysts are indication to laparoscopic fenestration with biopsy in case of evidence of symptoms. Polycystic liver diseases are treated conservative and surgical treatment is indicated at outstanding and apparent symptomatology of this disease, where is possible to demonstrate preoperatively one or more dominant cysts.

Key words:
liver cyst – laparoscopic fenestration – polycystic liver disease

Sources

1. Palanivelu, C., Rangarajan, M., Senthilkumar, R., Madankumar, M. V. Laparoscopic management of symptomatic multiple hepatic cysts: a combination of deroofing and radical excision. JSLS, 2007, 11: 466–469.

2. Pouston, G. J., Blumgart L. H. Surgical management of hepatobiliary and pancreatic disorders. Martin Dunitz, London 2003, 193–203.

3. Vyhnánek, J., Duda, M., Gryga, A., Dlouhý, M., Czudek, S. Miniinvasive approach to the treatment of liver cysts. Acta Univ. Palacki Olomouc Fac. Med., 1999, 142: 123–126.

4. Králová, M., Koudelka, J., Preis, J., Kuliaček, P., Eliáš, P. Kongenitální solitární cysta jater. Rozhl. Chir., 1994, 73: 384–385.

5. Gigot, J. F., Hubert, C., Banice, R., Kendrick, M. L. Laparoscopic management of benign liver diseases: where are we? HPB, 2004, 6: 197–212.

6. Grunfeld, J. P., Albouze, G., Jungers, P. Liver changes and complicationsin adult polycystic kidney disease. Adv. Nephrol., 1985, 14: 1–20.

7. Gigot, J. F., Jadoul, P., Que, F. Adult polycystic liver disease. Is fenestration the most adequate operation for long-term management? An. Surg., 1997, 225: 286–294.

8. Saini, S., Mueller, O.R., Ferrucci, J. T. Percutaneous aspiration of hepatic cysts does not provide definitive therapy. AJR, 1983, 141: 559–560.

9. Larssen, T. B., Viste, A., Jenssen, D. K. Single-session alcohol sclerotherapy in benign symptomatic hepatic cysts. Acta Radiol., 1997, 38: 993–997.

10. Zerem, E., Imamović, G., Omerović, S. Percutaneous treatment of symptomatic non-parasitic benign liver cysts: single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure. Eur. Radiol., 2008, 18: 400–406.

11. Bean, W. J., Rodan, B. A. Hepatic cysts: treatment with alcohol. AJR, 1985, 91: 237–241.

12. Blumgart, L. H. Surgery of the liver, biliary tract and pancreas. Saunders Elsevier, Philadelphia 2007, 1005–1021.

13. Nanashima, A., Sumida, Y., Nagayasu, T. Surgical treatments in cystic diseases of the liver: experience at a single center in Japan. Hepatogastroenterology, 2007, 54: 849–853.

14. Sutnar, A., Skalický, T., Třeška, V., Hess, O., Mírka, H., Michal, M., Novák, P., Liška, V. Cystadenom jater s ovariálním stromatem – kazuistika. Rozhl. Chir., 2008, 87: 259–262.

15. Hoevenaren, I. A., Wester, R., Schrier, R. W., McFann, K., Doctor, R. B., Drenth, J. P., Everson, G. T. Polycystic liver: clinical characteristics of patients with isolated polycystic liver disease compared with patients with polycystic liver and autosomal dominant polycystic kidney disease. Liver Int., 2008, 28: 264–270.

16. Ishibashi, K., Midorikawa, T., Sanada, Y. Is fenestration a safe treatment for adult polycystic liver disease?: A report of refractory complications. Hepatogastroenterology, 2004, 51: 1165–1167.

17. Z’Graggen, K., Metzger, A., Klaiber, C. Symptomatic simple cysts of the liver: treatment by laparoskopic surgery. Surg. Endosc., 1991, 5: 224–225.

18. Skalický, T., Třeška, V., Sutnar, A., Liška, V., Mírka, H., Ohlídalová, K., Ferda, J. Surgical treatment of benign liver tumors. Bratisl. Lek. Listy, 2005, 106: 330–332.

19. Moravec, R., Paulík, J., Matis, P., Ohrádka, B., Filo, F. K diagnostike a chirurgickej liečbe cýst pečene. Rozhl. Chir., 1985, 64: 340–345.

20. Varin, O. C., Varin, D. S., Berrevoet, F. C. Cystic lesions in the liver: benign or malignant? Acta Chir. Belg., 2007, 107: 554–556.

21. Černý, J., Beláček, J. Solitárne cysty pečene – léčebný problém. Rozhl. Chir., 1990, 69:99–102.

22. Giuliante, F., D‘apito, F., Vellone, M., Giovannini, I., Nuzzo, G. Risk for laparoscopic fenestration of liver cysts. Surg. Endosc., 2003, 17: 1735–1738.

23. Russell, R. T., Pinson, C. W. Surgical management of polycystic liver disease. World J. Gastroenterol., 2007, 13: 5052–5059.

24. van Keimpema, L., Ruurda, J. P., Ernst, M. F., van Geffen, H. J., Drenth, J. P. Laparoscopic fenestration of liver cysts in polycystic liver disease results in a median volume reduction of 12.5%. J. Gastrointest. Surg., 2008, 12: 477–482.

25. Bai, X. L., Liang, T. B., Yu, J., Wang, W. L., Shen, Y., Zhang, M., Zheng, S. S. Long-term results of laparoscopic fenestration for patients with congenital liver cysts. Hepatobiliary Pancreat. Dis. Int., 2007, 6: 600–603.

26. Neri, V., Ambrosi, A., Fersini, A., Valentino, T. P. Laparoscopic treatment of biliary hepatic cysts: short- and medium-term results. HPB, 2006, 8: 306–310.

27. Zacherl, J., Scheuba, C., Imhof, M., Jakesz, R., Függer, R. Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts. Surg. Endosc., 2000, 14: 59–62.