The management of hepatobiliary cystadenomas: lessons learned

AbstractBackgroundMucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years.MethodsA retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997–2011. Clinical data were collected and summarized.ResultsThirteen patients (mean age 51 years, 12/13 females) with cysts 4.6–18.1cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false‐negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90‐day mortality. All but one patient (myocardial infarction) were alive at a median follow‐up of 23.1 months. No patient with unroofing has developed malignancy to date.ConclusionsNon‐invasive hepatobiliary cystadenomas present as large central/left‐sided cysts in young or middle‐aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra‐operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow‐up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high‐quality imaging

Surgical Management of Colorectal Liver Metastases

Colorectal cancer is the third most commonly diagnosed cancer with approximately half of the patients developing liver metastases during the course of their disease. Modern multimodal therapies have improved the overall survival. Liver resection remains the most important modality in the treatment of colorectal liver metastases. The evolution of the criteria for resectability has resulted in more patients being offered a hepatectomy. This is further augmented with the utilization of adjuncts to liver resection, including portal vein embolization and local ablative techniques. Two-stage hepatectomy is also being used to increase resectability. Overall survival is improved by the deployment of new chemotherapeutic agents and the use of combination chemotherapy. Neoadjuvant chemotherapy is a promising development in the treatment of colorectal liver metastases. Patients with colorectal liver metastases can achieve long-term survival. A multidisciplinary approach is essential in the management of these patients

Liver resection for non-colorectal, non-carcinoid, non-sarcoma metastases: a multicenter study.

The role of liver resection for non-colorectal, non-neuroendocrine, non-sarcoma (NCNNNS) metastases is ill-defined. This study aimed to examine the oncologic outcomes of liver resection in such patients.A retrospective analysis of liver resection for NCNNNS metastases was performed at two large centers. Liver resection was offered selectively in patients with stable disease. Oncologic outcomes were examined using the Kaplan-Meier method.Fifty-two patients underwent liver resection for NCNNNS metastases. Overall 5-year survival was 58%. Five-year survival was 85% for breast metastases, 66% for ocular melanoma, 83% for other melanomas, 50% for gastro-esophageal metastases, and 0% for renal cell carcinoma metastases. A contemporary colorectal liver metastasis cohort had a survival of 63% (p=0.89).Liver resection is an effective option in the management of selected patients with NCNNNS metastases which have been deemed stable. Five-year survival rates were comparable to that of a contemporary cohort of patients with colorectal liver metastases in carefully selected patients. Further, larger studies are required to help identify potential prognostic variables and aid in decision-making in this heterogeneous population

Demographics & Metastatic Characteristics.

<p>* Data on chemotherapy is missing for 17 patients.</p><p>Demographics & Metastatic Characteristics.</p

Operations carried out and perioperative outcomes.

<p>Operations carried out and perioperative outcomes.</p

Overall survival of patients in the NCNNM cohort compared to the CRLM cohort.

<p>Overall survival of patients in the NCNNM cohort compared to the CRLM cohort.</p

Sites of primary tumors for those that underwent liver resection for NCNNNS metastases.

<p>Abbreviations—NCNNNS: non-colorectal, non-neuroendocrine, non-sarcoma metastasis.</p><p>* The histology of the 2 testicular cancers was non-seminomatous & yolk sac.</p><p>** The histology of the 2 thyroid cancers was medullary carcinoma.</p><p>Sites of primary tumors for those that underwent liver resection for NCNNNS metastases.</p