Laparoscopic liver resection for cystic lesions: A 20-year experience

Elie K Chouillard1, Chady Salloum, MD2, Yves Lopez, MD1, Andrew Gumbs, MD1, Daniel Azoulay, MD2. 1PARIS POISSY MEDICAL CENTER, 2HENRI MONDOR HOSPITAL

Introduction: In France, the vast majority of liver cystic lesions are either simple liver cysts (SC) or hydatid cysts (HC). If symptomatic, SC is best treated by laparoscopic unroofing. A HC is treated by simple cystectomy or pericystectomy. The aim of this study was to review the management strategy in patients who presented with atypical cysts. The results of laparoscopic approach to such patients were analysed.

Methods and Procedures: This is a retrospective review of patients who had liver resection for cystic lesions between January 1, 1995, and December 31, 2014. Management strategies were detailed, including clinical, biological, and imaging features. Operative morbidity and mortality as well as long-term outcome were also assessed. A comparison between preoperative and postoperative diagnoses was performed.

Results: Forty-nine patients (33 women and 16 men) underwent 59 liver resections, including 20 left lateral resections, 15 right hemi-hepatectomies, 12 left hemi-hepatectomies and 12 segmentectomies or wedge resections. Thirty-four patients (69.4 %) had 37 laparoscopic procedures and were the subjects of this study. The final diagnosis included HC in 12 patients (35.3 %), cystadenoma in 7 (20.6 %), SC in 4 (11.8 %), Caroli's disease in 4 (11.8 %), cystadenocarcinoma in 2 (5.9 %) and miscellaneous in the 5 remaining (14.6 %). There was no mortality and the postoperative morbidity rate was 16.2 %. Long-term follow-up revealed that, besides patients with malignancies whose outcome was dismal, overall prognosis was positive with efficacious symptom control.

Conclusions: Accurate preoperative diagnosis of liver cystic lesions may be difficult. However, laparoscopic liver resections for such lesions are safe and provide long-term symptomatic control in benign disease and may be curative in some cases of underlying malignancy. Even if almost half of liver cystic lesions treated by resection were either symptomatic SC or HC, we recommend en-bloc liver resection for all liver cystic lesions that are not clearly parasitic or SC.

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