Management and long-term follow-up of hepatic cysts

Purpose: To provide an algorithm for the management of hepatic cysts throug h an analysis of our series over 16 years. Method: We reviewed the surgical management and outcome of patients with he patic cysts between 1984 and 2000 at a single institution. Data were collec ted by chart review, telephone interview, and follow-up hepatic ultrasonogr aphy; Results: Forty-four patients (36 females, 8 males) underwent a total of 46 operations for hepatic cysts (mean size 12.0 +/- 5.2 cm) with a mean follow -up of 5.1 +/- 4.0 years. We treated's simple cysts, 4 polycystic liver dis ease (PCLD), 7 cystadenomas, 2 hydatid cysts, 1 cystadenocarcinoma, 1 endom etrioma, and 1 hepatic foregut cyst. Operations included simple drainage, w ide unroofing (open and laparoscopic), and hepatic resection. Four patients experienced a symptomatic recurrence after definitive treatment; 3 of thes e patients had PCLD. Four of the 7 patients with cystadenomas had undergone previous operations that required subsequent definitive resection without a recurrence. Conclusions: The preoperative distinction between simple cysts and cystaden omas/cystadenocarcinomas can be difficult, yet the manage ment is different . Unroofing is a safe and effective operation for patients with simple cyst s. Patients with PCLD frequently have recurrences. Cystadenomas should be c ompletely resected owing to the Likelihood of recurrence after partial exci sion and the risk of eventual cystadenocarcinoma. We present a treatment al gorithm for the preoperative evaluation and management of hepatic cysts bas ed on the largest number of patients with the longest follow-up reported to date. (C) 2001 Excerpta Medica, Inc. All rights reserved.