Should benign tumors of the liver be operated

OBJECTIVES: To define a strategy for benign liver tumours treatment and to report our experience. DESIGN: A retrospective study. PATIENTS: Sixty-eight patients operated for benign liver tumours among 424 operated of liver resection. RESULTS: Benign liver tumours were discovered during radiologic exploration for upper abdominal pain in 69%, incidentally during radiologic examination in 23% or at laparotomy in 8% of patients. Preoperative assessment of solid benign liver tumours was based on 4 radiologic examinations in average whereas cystic lesions needed only 2. The surgical treatment ranged from a simple tumorectomy to liver transplantation depending on the type, size and location of the tumour. There were no postoperative deaths and minor complications occurred in 7 patients (10%). Twenty hemangiomas, 20 hepatic cysts, 22 focal nodular hyperplasias (FNH), 4 hepatic adenomas (HA) and 2 cystadenomas were found on histology. The final diagnosis differed from the preoperative one in 36 patients (53%). CONCLUSIONS: Differential diagnosis for cystic lesions are the hepatic cyst, the hydatid cyst and the cystadenoma. Hydatid cysts and cystadenomas are resected whereas the asymptomatic hepatic cyst is left untreated. Hemangiomas must be resected only when symptomatic or pedunculated. The differentiation between FNH, HA and hepatocellular carcinoma is difficult and final diagnosis is most often achieved only by surgery.