Surgical Management of Cystic Liver Disease / 한국간담췌외과학회지

ABSTRACT

BACKGROUND: Cystic liver disease is a rare disease entity, but its surgical management can vary from partial excision to hepatic lobectomy. This study was conducted to evaluate proper surgical management of cystic liver disease. METHODS: The authors reviewed the medical records of 26 patients who underwent operative management for cystic liver disease, consisting of 15 cases of simple cyst, 7 cases of biliary cystadenoma, 1 case of biliary cystadenocarcinoma, 1 case of polycystic disease and 2 cases of Caroli's disease. RESULTS: The 26 patients had a mean age of 57, with a male to female ratio of 1:4. Patients' main symptoms were right upper quadrant pain or discomfort, and epigastric pain. Their main physical findings were palpable mass and direct tenderness, but 23% of patients were aymptomatic and 35% had no physical findings. Preoperative diagnosis was made with abdominal ultrasound and computed tomogram. Intervening septum was identified in 27% of simple cysts and 100% of biliary cystadenoma. However neither diagnostic tool has 100% diagnostic accuracy. All cysts except polycystic disease were located at either both hepatic lobes but more right lobe in simple cysts. The mean size of all cysts were 10.2cm ranging from 2-to-22cm without any difference among simple cysts, cystadenomas, and cystadenocarcinoma. Operative methods for simple cysts were partial cystectomy with marsulpialization, total cystectomy and hepatic segmentectomy in 87% of cases, of which 2 cases were performed by laparoscopic approach. However partial cystectomy was confined to unilocular simple cyst. There was no recurrence of simple cyst postoperatively. Biliary cystadenoma were managed by total cyst excision, hepatic segmentectomy or lobectomy in 86% of cases, but one cystadenoma was managed by partial cystectomy with marsulpialization had a persisting cyst. One patient with polycystic liver disease died because of overwhelming sepsis with postoperative acute renal failure. CONCLUSION: For unilocular simple cyst, partial cystectomy with marsulpialization can be an acceptable surgical procedure, even with a laparoscopic approach. But for biliary cystadenoma, the cyst should be totally removed at least to prevent recurrence and transformation to cystadenocarcinoma. Therefore, correct preoperative diagnosis is a prerequisite for appropriate selection of operative methods.