Abstract
Background: Due to the limited data comparing treatment outcomes of simple liver cysts (SLCs), there is, at present, no consensus on the optimum surgical treatment method for symptomatic SLCs. The objective of this paper was to review the outcomes for surgically managed SLCs carried out at our institution. Methods: A database search was performed to identify all patients who, between January 2003 and December 2012, underwent surgical intervention with a preoperative diagnosis of symptomatic SLCs at our institution. Retrospective analysis of patient demographics, symptoms, cyst characteristics including number, size, location and imaging features, operative management, postoperative morbidity and mortality, length of hospital stay, final histopathological diagnosis and long-term outcomes were performed. Results: Between January 2003 and December 2012, 28 patients underwent surgical intervention for symptomatic SLCs at our institution. Twenty-four were female (85.7%) and four were male (14.3%), with a mean age of 58 years. Laparoscopic fenestration was performed in 11 patients (39.3%), open fenestration in four (14.3%), laparoscopic resection in six (21.4%) and open resection in seven (25%). The mean cyst diameter was 8.97 ± 5.11 cm. Operative mortality was 3.6% (n = 1). Complications developed in two patients (7.2%), including pleural effusion (n = 1) and perihepatic abscess (n = 1). The final histopathology demonstrated an SLC in 23 patients (82.1%), cystadenoma in four (14.3%) and cystadenocarcinoma in one patient (3.6%). Length of hospital stay was 2.38 ± 2.06 days for the laparoscopic group and 7 ± 3.12 days for the open surgery group. Two patients (7.14%) experienced asymptomatic recurrence of cyst. The mean length of follow-up was 25.1 months (range 12 - 104.1) and the overall survival rate at 1 year was 96.4%. Conclusion: Laparoscopic fenestration is a safe and effective treatment for symptomatic SLCs. Open fenestration should be considered for large cysts, cysts presenting difficult laparoscopic access, and cysts with atypical features. Atypical features should prompt intraoperative frozen section and, if necessary, liver resection. J Curr Surg. 2015;5(1):129-132 doi: http://dx.doi.org/10.14740/jcs263w
Highlights
Liver cysts may arise from the biliary tree or from hepatic tissue
Liver cysts include non-parasitic simple liver cysts (SLCs), multiple cysts that occupy less than 50% of the liver volume, polycystic disease that occupies more than 50% of the liver volume and acquired cysts, which may be the result of parasitic, bacterial, or amoebic infection
There is a female preponderance for symptomatic SLC, with a ratio of 9:1 [4, 6,7,8]
Summary
Liver cysts may arise from the biliary tree or from hepatic tissue. Liver cysts include non-parasitic simple liver cysts (SLCs), multiple cysts that occupy less than 50% of the liver volume, polycystic disease that occupies more than 50% of the liver volume and acquired cysts, which may be the result of parasitic, bacterial, or amoebic infection. There is a female preponderance for symptomatic SLC, with a ratio of 9:1 [4, 6,7,8]. The 5-10% of SLC that present with symptoms do so because of mechanical compression, rupture, hemorrhage into the cyst, or infection [10]. Due to the limited data comparing treatment outcomes of simple liver cysts (SLCs), there is, at present, no consensus on the optimum surgical treatment method for symptomatic SLCs. The objective of this paper was to review the outcomes for surgically managed SLCs carried out at our institution
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