Systematic Review on Percutaneous Aspiration and Sclerotherapy versus Surgery as First-line Treatment in Symptomatic Simple Hepatic Cysts

Abstract

Background: Simple, non-parasitic, non-polycystic hepatic cysts (SHCs) may cause pain and bloating which impairs quality of life (QoL). Treatment options include percutaneous aspiration and sclerotherapy (PAS), and laparoscopic or open surgical management. Current guidelines recommend laparoscopic deroofing as primary treatment. This review assesses the effect of PAS and surgery on the symptoms and QoL in patients with SHCs. Methods: A systematic search in MEDLINE (PubMed) and Embase was performed according to PRISMA guidelines. Studies reporting symptoms before and after treatment of SHCs were included. Methodological quality of included studies was assessed by the MINORS-tool. Primary outcomes were symptom relief and QoL. Secondary outcomes were recurrence and complications. Pooled estimates were produced using the Mantel-Haenszel method. Results: In total, 764 patients from 34 studies with SHCs were included, of which 294 (38.5%) underwent PAS, 348 (45.5%) laparoscopic, and 122 (16.0%) open surgical management. Prior to surgical management, 9.9% (95% CI: 9.1-10.6%) of patients underwent other treatment. Symptom relief (percentage with 95% CI) was accomplished in 92.5% (91.7-93.3%), 91.4% (90.6-92.2%), 86.9% (84.9-88.9%) of patients treated with PAS, laparoscopic or open surgery, respectively. QoL was rarely examined. Cyst recurrence rates were 0.3% (0.3-0.4%), 16.4% (14.9-17.8%) and 13.1% (11.1-15.1%). Major complication rate was 0.7% (0.6-0.8%), 1.7% (1.6-1.9%) and 2.5% (2.0-2.9%), respectively. Conclusions: Similar results were found for PAS and surgery with respect to symptom relief and complications. PAS was associated with lower cyst recurrence rates than surgery. We advocate PAS as primary treatment in a step-up protocol for SHCs.