Relief of Symptoms and Quality of Life after Conservative versus Surgical Treatment of Benign Liver Tumors (CONSULT): A Retrospective Propensity Score Matched Study

Abstract

Introduction: Surgery can be considered for patients with benign liver tumours (BLTs) with risk of malignancy, complications, or severe symptoms. The effect of surgery on symptoms and quality of life (QoL) remains debatable. The aim of this study was to compare symptoms and QoL after surgical or conservative management of BLTs. Methods: In this dual-site retrospective study, adult patients with hepatocellular adenoma, focal nodular hyperplasia, or haemangioma diagnosed between 2000 and 2019 were included. SumScores and general QoL scores at follow-up were compared between propensity-score matched, surgically and conservatively managed patients. Higher scores indicate more symptoms and a higher QoL, respectively. Results: Among 221 included patients, 50 (22.6%) were treated surgically and 171 (78.4%) conservatively. Surgical patients were younger, with lower baseline QoL, and more often had left-sided and larger tumours. At follow-up, median 91-100 months after diagnosis, surgical patients had higher SumScores (mean difference 9.2, 95%CI 1.0-17.4, p=0.028) but not higher general QoL scores (p=0.331) than their propensity-score matched, conservatively treated counterparts. Surgical patients also had higher emotional (p=0.010) and cognitive (p=0.009) functioning scores, less insomnia (p=0.026), less appetite loss (p=0.012), less bloating (p=0.006), less weight gain (p=0.035) and less pain (p=0.027). Most reported stable, improved or disappearance of symptoms (41/47 patients) and would undergo surgery again (44/47 patients). Conclusion: More than seven years after diagnosis, surgical patients had less symptoms than conservatively managed patients, although QoL was not significantly different. These results may support currently available recommendations and further guide treatment selection.