New Insights in the Management of Hepatocellular Adenoma

Anne J. Klompenhouwer; Robert A. de Man; Marco Dioguardi Burgio; Valerie Vilgrain; Jessica Zucman-Rossi; Jan N. M. Ijzermans


Liver International. 2020;40(7):1529-1537. 

In This Article

How to Treat

Elective surgical resection is the gold standard in the treatment of patients with HCA. Resection of HCA can safely be performed with either an open or laparoscopic approach.[59] Although laparoscopy may require more advanced surgical skills and is dependent on the size and location of the tumour, it also has great benefits as compared to an open approach, including a reduction in blood loss and a shorter duration of hospital stay.[60,61]

Other treatment methods investigated for the treatment of HCA are transarterial embolization (TAE) and tumour ablation (either radiofrequent ablation or microwave ablation). TAE is a well-established treatment to use for HCA showing acute haemorrhage with hemodynamic instability,[51] but recent studies have also investigated its safety and efficacy in the elective treatment of non-haemorrhaging HCA. TAE appears to be a safe and can lead to size reduction of HCA, although its effect is difficult to distinguish from the ongoing effect of cessation of oral contraceptives.[62,63] Additionally, the effect TAE has on the risk of malignant transformation is still unclear. Tumour ablation might also be used in the treatment of HCA, but often multiple sessions are required and patients might still have residual HCA despite repetitive treatment.[64] Both TAE and tumour ablation techniques may only be beneficial in patients with small lesions who are poor surgical candidates.[11]

Liver transplantation has been proposed as a treatment for patients with many widespread HCA (>10, liver adenomatosis). To date, this is no longer considered an indication for liver transplantation.[57] Liver transplantation is a major procedure and given the organ shortage, it should be reserved for those with histological evidence of malignancy that cannot be treated with liver resection.[65] The only patients with HCA that might be considered for liver transplantation are men with widespread nonresectable HCA and patients with glycogen storage disease and multiple progressing HCA at risk for malignant transformation.