Has laparoscopy increased surgical indications for benign tumors of the liver?
Benign liver tumors often require surgical treatment because of the diagnostic difficulties of their nature and because of annoying symptoms. With the aim of assessing if surgery is a safe therapeutic option we reviewed the data concerning 36 consecutive patients who underwent hepatic resection during the period January 1988-January 1993 at our Institution for 42 presumed benign liver tumors. Patients had a preoperative assessment consisting of biochemical tests, abdominal echography and contrast-enhanced scan in all cases, magnetic resonance imaging in 6 cases, celiacmesenteric angiography in 14 cases and percutaneous liver biopsy in 5 cases. We realised 5 major hepatectomies and 31 minor resections. There was no perioperative mortality. The postoperative complication rate was 5.5%. Mean hospital stay was 15.1 days (range 5-35 days). On follow-up, ranging from 4 to 60 months (mean 24 months), all patients are alive, without recurrence and free of symptoms. Histologic examination of specimens showed cavernous hemangioma in 20 cases, focal nodular hyperplasia in 19 cases and hepatic adenoma in 3 cases. Histologic findings were in accord with preoperative diagnosis in 57.9% of cases of cavernous hemangioma, in 42.8% of cases of focal nodular hyperplasia and in no case of hepatic adenoma. Our experience confirms that accurate preoperative diagnosis of presumed benign liver tumors is difficult in spite of complete radiologic investigations and liver biopsy. For this reason and for the risk of dangerous complications, such as malignant transformation and intraperitoneal hemorrhage, we believe that surgery is the treatment of choice in the majority of cases. This attitude, when realised in a center with experience in hepato-biliary surgery and using modern technical features is safe and efficient.