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Hepatic adenoma
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of hepatic adenoma are prepared by our editorial team based on guidelines from the Enhanced Recovery After Surgery Society (ERASS 2023), the European Association for the Study of the Liver (EASL 2023,2019,2016), the American College of Radiology (ACR 2020), the European Federation of Societies for Ultrasound (EFSU 2020), and the American ...
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Classification and risk stratification
Diagnostic investigations
Contrast-enhanced ultrasound
As per ACR 2020 guidelines:
Obtain contrast-enhanced abdominal ultrasound of an indeterminate > 1 cm liver lesion on initial ultrasound in patients with a normal liver with no suspicion or evidence of extrahepatic malignancy or underlying liver disease.
B
Obtain contrast-enhanced abdominal ultrasound of an incidental liver lesion > 1 cm on initial ultrasound, non-contrast or single-phase CT, or non-contrast MRI in patients with known chronic liver disease.
B
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Cross-sectional imaging
Diagnostic procedures
Medical management
Therapeutic procedures
Perioperative care
Preoperative care, counseling
As per ERASS 2023 guidelines:
Provide preoperative information and counseling regarding the upcoming liver surgery. Consider using brochures and multimedia support to improve verbal counseling.
B
Advise preoperative smoking cessation at least 4 weeks before hepatectomy. Advise alcohol cessation in heavy drinkers (> 24 g/day for females or > 36 g/day for males) 4-8 weeks before surgery.
A
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Preoperative care (nutrition)
Preoperative care (rehabilitation)
Preoperative care (biliary drainage)
Preoperative care (antibiotic prophylaxis)
Preoperative care (corticosteroids)
Preoperative care (preanesthetic medication)
Intraoperative care (anesthesia and analgesia)
Intraoperative care (temperature management)
Intraoperative care (fluid management)
Postoperative care (thromboprophylaxis)
Postoperative care (early mobilization)
Postoperative care (nutrition)
Postoperative care (antiemetics)
Postoperative care (laxatives)
Surgical interventions
Surgical resection, indications: as per EASL 2016 guidelines, perform resection in patients with hepatocellular adenoma irrespective of size in males and in any instance of proven β-catenin mutation.
B
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Liver transplantation
Surgical resection (technical considerations)
Specific circumstances
Pregnant patients
As per EASL 2023 guidelines:
Do not offer additional interventions in female patients with hepatic adenomas with a diameter < 5 cm, as pregnancy does not increase the risk of complications related to the tumor. Obtain ultrasound assessment as some tumors may increase in size.
D
Offer treatment before pregnancy where possible in patients planning a pregnancy with a hepatic adenoma with a diameter > 5 cm, as these tumors are associated with an increased risk of enlargement and hemorrhage.
B