Large Size Is Not a Contraindication to Laparoscopic Resection of Hepatocellular Adenoma

Introduction: Hepatocellular adenoma (HCA) is a neoplastic liver lesion with an increasing incidence and a strong association with oestrogen therapy. Laparoscopic resection has proven safe for small lesions whilst its use for large adenomas (≥10cm) requires further investigation. Methods: All patients undergoing laparoscopic liver resection for HCA at the Royal Brisbane Hospital between January 2003 - April 2018 were analysed. Results: 33 laparoscopic resections were performed in 32 female patients with a median age of 36 years (range 26 - 75). Nine (27%) laparoscopic resections were performed for large adenomas (≥10cm) and 17 laparoscopic resections were performed for adenomas of intermediate size (5 - 9.9cm). No conversions to open were required in the large group whilst there was one case in the intermediate group. Haemorrhage, either intra-parenchymal or free intraperitoneal, was the indication for resection in 44% of the large group. Median operative time was 266 minutes in the large group reflecting that hemi-hepatectomy was performed in 55% of cases compared with none in the intermediate group (median operative time 143 minutes). No major complications (Clavien-Dindo IIIb or greater) were seen in the large adenoma group and only one patient required transfusion. The median length of stay for large lesions was 5 days (range 4 - 9) which was comparable to the intermediate group (4 days, range 1 - 11). Conclusions: Laparoscopic surgery has been demonstrated to be safe for the resection of HCA in this group of patients. Importantly, large size is not a barrier to laparoscopic resection.