Long-term outcomes of resection in patients with symptomatic benign liver tumors

Abstract

Aims: Benign liver tumors (hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH), hemangioma) may be correlated with symptoms. Surgical intervention for alleged symptoms is controversial. We assessed long-term relief of complaints in patients who had undergone resection for symptomatic benign liver tumors. Methods: 37 Patients with benign tumors (HCA 19, FNH 12, hemangioma 3, cysts 3) were included in a prospective study. Validated McGill Pain Questionnaires were filled in preoperatively and 22 to 146 months (median 53 months) after surgery. The questionnaire included a visual analogue score (VAS) and a Pain Rating Index (PRI). Outcomes were evaluated using descriptive statistics, paired sample T-test and (M)ANOVA. Results: Initial tumor size was 2–20 cm (median 7.9 cm). 2/37 patients returned incomplete questionnaires. 29/36 (81%) patients reported improvement of quality of life after surgery. In these patients, VAS was reduced from 5.62 to 1.62 (P < 0,001) and PRI from 20,8 to 10,3 (P = 0,001). 16/37 (43%) patients reported persisting (2 patients) or new (14 patients) complaints: incisional hernia (n = 3), discomfort of scar (n = 6) and other (n = 7). 32/35 (91%) patients would choose to undergo surgery again, one might, and 2 would not. No correlation was found between tumor size, and pain or other complaints. Type of surgery did not significantly influence outcome (open versus laparoscopic surgery, major versus minor resection). Patients with a left sided liver tumor had higher initial PRI compared to patients with a right sided tumor (16,3 versus 5,8 (P = 0.026), and showed greater relative improvement (VAS decreased 4,3 points in left versus 3,8 in right sided tumors (P = 0,017). Conclusions: With a median follow-up of 53 months, 81% of patients who had undergone resection for complaints of a benign liver lesion experienced long-term improvement of symptoms and benefitted from surgical intervention.