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Elective surgery for benign liver tumours

  • Review
  • Intervention

Authors


Abstract

Background

Benign liver tumours (haemangioma, focal nodular hyperplasia, and hepatic adenoma) have different prevalence and prognosis. Spontaneous rupture and malignant transformation can complicate hepatic adenoma. Elective surgery is controversial, and indications are represented by uncertain diagnosis, presence of symptoms, and prevention of major complications.

Objectives

To assess the beneficial and harmful effects of elective surgery of benign liver tumours. We identified 31 cases series. These were small (with less than 60 participants) and the types of tumours mixed. These studies reported no significant mortality, but in the six studies with mortality it ranged from 1% to 17%.

Search methods

The Cochrane Hepato-Biliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (searches in Issue 1, 2006), MEDLINE, EMBASE, CancerLit, and Science Citation Index Expanded (SCI-EXPANDED) (searched December 2005). A further search included the proceedings of major hepatological and surgical congresses (Annual Meetings of the American Association for the Study of the Liver (AASLD) and European Association for the Study of the Liver (EASL)), and examination of the references of relevant papers and reference lists of the identified studies.

Selection criteria

Randomised clinical trials in adult patients with benign liver tumours without indications for emergency surgery in which elective surgery (resection) versus no intervention or sham operation are compared.

Data collection and analysis

All trials identified through searches were evaluated for eligibility for inclusion. We intended to extract relevant data in order to analyse the outcomes as per our published protocol using intention-to-treat analysis.

Main results

We could not identify any randomised clinical trials.

Authors' conclusions

We were unable to find evidence supporting or refuting elective surgery for patients with benign liver tumours. We need large, long-term randomised clinical trials with adequate methodology to assess the benefits and harms of elective surgery.

摘要

背景

治療良性肝臟腫瘤的選擇性手術

良性肝臟腫瘤(血管瘤, 肝局灶性結節性增生和肝腺瘤)包括不同的流行程度和診斷結果。自發性破裂和惡性變化為肝腺瘤之併發症。選擇性手術具有爭議,其手術適應症取決於診斷的明確性、症狀存在與否、主要併發症的預防。

目標

評估良性肝臟腫瘤的選擇性手術利弊。我們確定31個個案系列。均是小規模(不到60位受試者)和混合幾種腫瘤類型的試驗。這些研究沒有記錄到有顯著死亡率,但是在6項研究中,死亡率的範圍從1% 到17%。

搜尋策略

搜尋了The Cochrane Library 中的The Cochrane HepatoBiliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (2006年第1期), MEDLINE, EMBASE, CancerLit和Science Citation Index Expanded(SCIEXPANDED) (2005年12月)。進一步搜尋結果納入主要肝臟和外科年會的記錄,(每年一度舉辦的美國肝病學會(AASLD)和歐洲肝病學會(EASL)),審查了相關文章的參考列表和已挑出的研究的參考列表。

選擇標準

對比選擇性手術(切除術)和無干預法或假手術治療患有良性肝臟腫瘤的成年病人的隨機臨床試驗,並且沒有緊急手術的適應症。

資料收集與分析

透過研究,判定符合收錄標準的試驗。為了分析我們發表的每份協議中的結果,我們使用治療意向分析提取相關資料。

主要結論

我們無法找出隨機臨床試驗。

作者結論

我們不能發現有證據支持或反對選擇性手術用於治療良性肝臟腫瘤病人。我們需要大規模,長期隨機臨床試驗,採用合適的研究方法來評估選擇性手術的利弊。

翻譯人

本摘要由臺中榮民總醫院王建得翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據支持或反對良性肝臟腫瘤的病人是否使用選擇性手術。最常見的良性肝臟腫瘤包括海綿狀血管瘤, 肝局灶性結節性增生和肝腺瘤.。多數病人沒有症狀,亦無治療適應症。血管瘤和肝局灶性結節性增生的病程一般無重大事件,但是肝腺瘤的自然病史卻會出現腫瘤破裂和出血等威脅生命的併發症。手術治療通常被建議用於併發症,或者需要組織學診斷時。但是,選擇性手術的使用在臨床照顧面的變異度蠻大(例如,出現併發症之前實施手術)。本次系統性回顧沒有確定有隨機臨床試驗,但是檢索到了31 個沒有適當控制組的個案系列。目前沒有證據支持或反對對良性肝臟腫瘤使用選擇性手術。

Plain language summary

No evidence to support or refute elective surgery for benign liver tumours

The most common benign liver tumours include cavernous haemangioma, focal nodular hyperplasia, and hepatic adenoma. The majority of patients are asymptomatic, and no treatment is indicated. The natural history of haemangioma and focal nodular hyperplasia is typically uneventful whereas that of hepatic adenoma can be complicated by life-threatening conditions, such as rupture and haemorrhage. For these complications or when a definite histologic diagnosis is needed, surgery is advisable. However, in clinical practice there is a wide variation concerning the use of elective surgery (ie, surgery performed before complications have developed). No randomised clinical trials were identified for this systematic review, but 31 case series without a proper control group were retrieved. Accordingly, there is no evidence to support or refute elective surgery for benign liver tumours.

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