Hepatic adenoma: indications for minimally invasive resection
Hepatic adenoma (HA) is a rare benign disease. Only selected patients require a liver resection: all male patients; female patients with a progressively enlarging nodule or HA >5 cm or β-catenin mutated tumors (especially if β-catenin mutated HA exon 3); symptomatic patients. We performed a review of the literature to analyze the indications and the results of a laparoscopic resection in patients with HA. The number of minimally invasive resections performed for HA reported in the literature has progressively increased in the most recent years. Laparoscopic resection of HA is safe and feasible and carries the same advantages of minimally invasive liver surgery for other diseases. The minimally invasive approach is standard for HA requiring limited resection of antero-lateral segments or left lateral sectionectomy. Laparoscopic complex resections for HA have been reported, but they are still under evaluation and should be reserved to high-volume centers with adequate expertise. A three-step decisional process should be respected. The surgeon should evaluate: firstly, if the patient needs surgery; secondly, which resection is appropriate; thirdly, if a laparoscopic approach is suitable in his/her center. The possibility to perform a laparoscopic resection for HA should not widen indications or modify surgical strategy. Furthermore, the surgeon’s awareness of his/her expertise and learning curve and that of the entire teams’ capabilities is paramount to increase patient safety and optimize outcomes.