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Indication for treatment and long-term outcome of focal nodular hyperplasia

Authors

  • GLENN K. BONNEY,

    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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  • DHANWANT GOMEZ,

    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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  • AHMED AL-MUKHTAR,

    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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  • GILES J. TOOGOOD,

    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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  • J. PETER A. LODGE,

    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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  • Mr RAJ PRASAD

    Corresponding author
    1. Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
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Mr K.R. Prasad, Consultant Hepatobiliary and Transplant Surgeon, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Tel +44 (0) 113 2065921. fax: +44 (0) 113 2448182. E-mail: raj.prasad@leedsth.nhs.uk

Abstract

Introduction. Unlike malignant liver tumours, the indications for hepatic resection for benign disease are not well defined. This is particularly true for focal nodular hyperplasia (FNH). Here we summarize a single-centre experience of the diagnosis and management of FNH. Materials and methods. Using a prospectively collected database, a retrospective analysis of consecutive patients who were managed at our centre for FNH between January 1997 and December 2006 was performed. Results. The cohort was divided into two groups of patients: those who were managed surgically (n=15) and those managed conservatively (n=37). There was no correlation between tumour size and number of lesions with oral contraceptive use (p=0.07 and 0.90, respectively) and pregnancy (p=0.45 and 0.60, respectively). However, tumour size (p=0.006) and number of lesions (p=0.02) were associated with the occurrence of pain in these patients. Pain was the commonest symptom of patients (13/15) who were managed surgically. All patients underwent radiological imaging before diagnosis. The sensitivities of ultrasound, CT scanning and MRI scanning in characterizing these lesions were 30%, 70% and 87%, respectively. There were no postoperative deaths and three postoperative complications that were successfully managed non-operatively. With a median follow-up of 24 months in the surgically treated group, one patient has developed recurrent symptoms of pain. Conclusion. In this series, there was no mortality directly due to the surgical procedure and a modest morbidity, justifying surgical resections in selected patients.

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