Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center
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SSAT POSTER PRESENTATION
Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center Axel Gomez 1 & Andrew D. Wisneski 1 & Hubert Y. Luu 1 & Kenzo Hirose 1 & John P. Roberts 1 & Ryutaro Hirose 1 & Christopher E. Freise 1 & Eric K. Nakakura 1 & Carlos U. Corvera 1 Received: 7 June 2020 / Accepted: 1 October 2020 # 2020 The Author(s)
Abstract Background Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. Methods Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. Results Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). Conclusions Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results. Keywords Liver cysts . Minimally invasive . Laparoscopy . Fenestration . Clinical outcomes
Introduction Hepatic cysts are found in 2.5–18% of the general population and carry a broad differential diagnosis1,2. Infectious etiologies include pyogenic abscess, amoebic abscess, and hydatid cyst, while non-infectious cysts include benign lesions such as simple liver cysts, ciliated foregut cysts, and Caroli disease3. Cystic neoplasms of the liver include entities such as biliary Abstract accepted for poster presentation at The Society for Surgery of the Alimentary Tract, 61st Annual Meeting, Session: SSAT Biliary Tract Diseases III (Final ID: Tu2046) * Carlos U. Corvera [email protected] 1
Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
cystadenoma, biliary cystadenocarcinoma, and liver metastases. Non-infectious hepatic cyst disease is often an inciden
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