Large cystic lesions of the liver in adults: A 15-year experience in a tertiary center

BACKGROUND: Cystic lesions of the liver consist of a heterogeneous group of disorders and may present a diagnostic and therapeutic challenge. Large he patic cysts tend to be symptomatic and can cause complications more often t han smaller ones. STUDY DESIGN: We performed a retrospective review of adults diagnosed with large (greater than or equal to 4cm) hepatic cystic lesions at our center, over a period of 15 years. Polycystic disease and abscesses were not includ ed. RESULTS: Seventy-eight patients were identified. In 57 the lesions were sim ple cysts, in 8 echinococcal cysts, in 8 hepatobiliary cystadenomas, and in 1 hepatobiliary cystadenocarcinoma. In four patients, the precise diagnosi s could not be ascertained. Mean size was 12.1 cm (range, 4 to 30 cm). Most simple cysts were found in women (F:M, 49:8). Bleeding into a cyst (two pa tients) and infection (one patient) were rare manifestations. Percutaneous aspiration of 28 simple cysts resulted in recurrence in 100% of the cases w ithin 3 weeks to 3 months (mean 4 1/2 months). Forty-eight patients were tr eated surgically by wide unroofing or resection (laparoscopically in 18), w hich resulted in low recurrence rates (11% for laparoscopy and 13% for open unroofing). Four of the eight patients with echinococcal cysts were sympto matic. All were treated by open resection after irrigation of the cavity wi th hypertonic saline. There was no recurrence during a followup period of 2 to 14 years. Hepatobiliary cystadenomas occurred more commonly in women (F :M, 7:1) and in the left hepatic lobe (left:right, 8:0). Seven were multilo culated. All were treated by open resection, with no recurrence, and none h ad malignant changes. Cystadenocarcinoma was diagnosed in a 77-year-old man , and was treated by left hepatic lobectomy. CONCLUSIONS: Large symptomatic simple cysts invariably recur after percutan eous aspiration. Laparoscopic unroofing can be successfully undertaken, wit h a low recurrence rare. Open resection after irrigation with hypertonic sa line is a safe and effective treatment for echinococcal cysts. Hepatobiliar y cystadenomas have predilection for women and for the left hepatic lobe. M alignant transformation is an uncommon but real risk. Open resection is a s afe and effective treatment for hepatobiliary cystadenoma, and is associate d with a low recurrence race. (J Am Coll Surg 2001;193:36-45. (C) 2001 by t he American College of Surgeons).