G. Garcea MD, FRCS; A. Rajesh MD, FRCS; A. R. Dennison MD, FRCS.
Surgical management of cystic lesions in the liver
Article first published online: 26 APR 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 7-8, pages E3–E20, July-August 2013
How to Cite
Garcea, G., Rajesh, A. and Dennison, A. R. (2013), Surgical management of cystic lesions in the liver. ANZ Journal of Surgery, 83: E3–E20. doi: 10.1111/j.1445-2197.2012.06096.x
- Issue published online: 28 JUL 2013
- Article first published online: 26 APR 2012
- Accepted for publication 16 January 2012.
- Caroli's disease;
- cystic liver tumours;
- hydatid cysts;
- liver abscess;
- non-parasitic hepatic cysts;
- parasitic cysts;
- polycystic liver disease
Background: Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear.
Methods: A Pubmed and Medline literature review using key words non-parasitic hepatic cysts, polycystic liver disease, echinococcus, hydatid cysts parasitic cysts, Caroli's disease, cystadenoma; liver abscess, surgery, aspiration and treatment was undertaken and papers pertaining to the diagnosis and management of cystic lesions within the liver were retrieved.
Results: Asymptomatic simple cysts in the liver require no treatment. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. At present, insufficient evidence exists to recommend one over the other. Polycystic liver disease presents a unique management problem because of high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can effectively be treated by aspiration or drainage. With improved antimicrobial efficacy, prolonged treatment with antibiotics may also be considered.
Conclusion: All patients with cystic lesions in the liver require discussion at multi-disciplinary meetings to confirm and the diagnosis and determine the most appropriate method of treatment.