Abstract
Background
Surgery can be considered for selected patients with benign liver tumours (BLT). The
aim of this study was to compare symptoms and quality of life (QoL) after conservative
and surgical management of BLT.
Methods
In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed
between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and
symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were
compared between surgically and conservatively treated patients by matched t-tests.
Propensity score matching attempted to reduce confounding. Higher scores indicate
less symptoms and higher QoL.
Results
Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included
at median 95 (IQR:66–120) and 91 (IQR:52–129) months, respectively. Most surgically
treated patients reported stable, improved or disappeared symptoms (87%) and would
undergo surgery again (94%). After propensity score matching, surgical patients had
higher SumScores (mean difference 9.2, 95%CI:1.0–17.4, p = 0.028) but not higher QoL
scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients
in both groups).
Discussion
Patients who had undergone surgery often reported they would undergo surgery again.
Moreover, they had less symptoms than conservatively managed patients while they were
propensity score matched on relevant variables, including baseline symptoms.
Graphical abstract
Graphical Abstract
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References
- Surgical management of hepatocellular adenoma: take it or leave it?.Ann Surg Oncol. 2008; 15: 2795
- A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas.Gastroenterology. 2009; 137: 1698-1705
- Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy.Ann Surg Oncol. 2009; 16: 640-648
- Molecular classification of hepatocellular adenoma associates with risk factors, bleeding, and malignant transformation.Gastroenterology. 2017; 152: 880-894.e6
- Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases.HPB. 2010; 12: 509-522
- IVIM-diffusion-MRI for the differentiation of solid benign and malign hypervascular liver lesions-Evaluation with two different MR scanners.Eur J Radiol. 2016; 85: 1289-1294
- Immunohistochemical markers on needle biopsies are helpful for the diagnosis of focal nodular hyperplasia and hepatocellular adenoma subtypes.Am J Surg Pathol. 2012; 36: 1691-1699
- Has laparoscopy increased surgical indications for benign tumors of the liver?.Langenbeck's Arch Surg. 2013; 398: 195-210
- Cavernous hemangioma of the liver.Surgery. 1958; 43: 577-582
- Management of haemangioma of the liver: comparison of results between surgery and observation.Br J Surg. 1991; 78: 1223-1225
- Management of giant liver hemangiomas: an update.Expet Rev Gastroenterol Hepatol. 2013; 7: 263-268
- EASL Clinical Practice Guidelines on the management of benign liver tumours.J Hepatol. 2016; 65: 386-398
- Long-term outcomes of resection in patients with symptomatic benign liver tumours.HPB. 2016; 18: 908-914
- Hepatocellular adenoma: an excellent indication for laparoscopic liver resection.HPB. 2012; 14: 390-395
- Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review.HPB. 2019; 21: 1119-1130
- The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- The EORTC QLQ-C30 scoring manual.3rd ed. European Organisation for Research and Treatment of Cancer, Brussels2001
- Multivariate and propensity score matching software with automated balance optimization: the matching package for R.J Stat Software. 2011; 42: 1-52
- Modern applied Statistics with S.4th ed. Springer, New York: Springer-Verlag2002: 169-177
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.Stat Med. 2009; 28: 3083-3107
- Size of lesion is not a criterion for resection during management of giant liver haemangioma.Br J Surg. 2002; 89: 1240-1244
- Outcomes of liver resection in hepatocellular adenoma and focal nodular hyperplasia.HPB. 2014; 16: 140-149
- Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only.Am J Surg. 2012; 204: 689-696
- Management of giant hemangioma of the liver: resection versus observation.J Am Coll Surg. 2010; 211: 724-730
- Case-orientated approach to the management of hepatocellular adenoma.Br J Surg. 2006; 93: 1495-1502
- Management of liver hemangiomas according to size and symptoms.J Gastroenterol Hepatol. 2007; 22: 1953-1958
- Management of hemangioma of the liver: surgical therapy or observation?.World J Surg. 2013; 37: 1303-1312
- Choosing patient-reported outcome measures for cancer clinical research--practical principles and an algorithm to assist non-specialist researchers.Eur J Cancer. 2010; 46: 3149-3157
- Improvements in quality of life after surgery for benign hepatic tumors: results from a dual center analysis.Surgery. 2012; 152: 193-201
- Will weight loss become a future treatment of hepatocellular adenoma in obese patients?.Liver Int. 2015; 35: 2228-2232
- Patient recall and recall bias of health state and health status.Expert Rev Pharmacoecon Outcomes Res. 2004; 4: 159-2232
- Measuring change in quality of life: bias in prospective and retrospective evaluation.Value Health. 2015; 18: 110-115
- Surgical outcomes of laparoscopic and open resection of benign liver tumours in The Netherlands: a nationwide analysis.HPB. 2021; 23: 1230-1243
- National trends in the use of surgery for benign hepatic tumors in the United States.Surgery. 2015; 157: 1055-1064
Article info
Publication history
Published online: March 02, 2023
Accepted:
February 28,
2023
Received:
November 4,
2022
Publication stage
In Press Corrected ProofFootnotes
☆Preliminary study results were presented as an ePoster at the 15th International Hepato-Pancreato-Biliary Assocation (IHPBA) World Congress, March 30-April 2, 2022.
Identification
Copyright
© 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc.
