This document discusses benign and malignant liver tumors. It covers common benign tumors like hepatic adenoma, focal nodular hyperplasia, and hemangioma. Malignant tumors discussed include hepatocellular carcinoma, cholangiocarcinoma, and metastatic cancers. Diagnostic workup and available treatment options are also summarized, including liver resection, ablation, and transplantation. The document concludes by outlining the benefits of minimally invasive robotic and laparoscopic liver surgery approaches.

1. Benign and Malignant Liver Tumors
ISWANTO SUCANDY MD, SHARONA ROSS, MD, ALEXANDER ROSEMURGY, MD
HEPATOPANCREATOBILIARY AND MINIMALY INVASIVE ROBOTIC SURGERY
THE SOUTHEASTERN CENTER FOR DIGESTIVE DISORDER
FLORIDA HOSPITAL, TAMPA, FL

2. BENIGN LIVER MASS
Hepatic Adenoma
Focal Nodular Hyperplasia
Liver Hemangioma
Liver Cysts
◦ Simple cyst
◦ Cystadenoma
MALIGNANT LIVER MASS
Hepatocellular carcinoma (95% in Liver Cirrhosis)
Intrahepatic Cholangiocarcinoma
Metastatic cancer to the liver
◦ Colon and rectal cancer
◦ Neuroendocrine cancer (NET)
◦ Soft tissue sarcoma
◦ Breast cancer
◦ Ovarian/Prostate cancers
◦ Others

3. Liver Mass
Most without symptoms upon presentation
Incidental findings on abdominal CT scan or MRI
Symptoms :
◦ Right upper quadrant fullness/discomfort/pain
◦ Elevated liver enzymes
◦ Jaundice

4. Diagnostic Work-Up
Liver enzymes (ALT, AST, Tbili, Alkaline phosphatase)
Triple tumor markers (AFP, CA 19-9, CEA)
Triphasic Liver CT scan (arterial, portal, washout phase)
Liver MRI (lesions <2cm)
Liver mass seen on Ultrasonography needs a Triphasic Liver CT scan

5. Available Treatment Modalities
Liver Resection (Robotic, Laparoscopic, Open, Hybrid technique)
Radiofrequency Ablation (Laparoscopic, Percutaneous, Open for lesions
< 3.5 cm diameter)
Regional Liver Therapy
◦ Transarterial Chemoembolization
◦ Transarterial Radioembolization
◦ Hepatic Artery Infusion Pump / Isolated Hepatic Perfusion Therapy
Focused External Beam Radiation
Liver Transplantation (shortage of donor, limited eligibility criterias, lifelong immunosuppression post
transplantation)

6. Hepatic Adenoma
Young female in reproductive age
Estrogen dependent (Oral contraception/Injection
most common)
Malignant degeneration and risk of
rupture/bleeding as size increases
Liver resection indicated for size > 4-5cm

7. Focal Nodular Hyperplasia
Benign
Nonhormonally dependent
Symptomatic with size increase
“Central scar” on CT scan
Liver resection indicated for symptomatic
lesion

8. Liver Hemangioma
Benign
Nonhormonally dependent
Symptomatic with size increase
Gradual centripetal arterial enhancement
Liver resection indicated for
symptomatic/consumptive lesion

9. Liver Cyst
Benign
Right upper quadrant discomfort from capsular
stretch
Can be very large >10cm in size / > 1 gallon of
fluid
Frequently multiple in both hemilivers
Robotic or Laparoscopic cyst wall resection /
fenestration

10. Hepatocellular Carcinoma
95% occur in background liver cirrhosis
In the US : Alcohol, Hepatitis C
Typical appearance on CT scan
Liver resection / Radiofrequency Ablation /
Liver Transplantation depending on stage

11. Intrahepatic Cholangiocarcinoma
Malignancy of intrahepatic bile duct
Normal background liver
Tend to spread to portal lymphnodes
Response to standard chemotherapy only 40%
Liver resection with negative margin --> only
potentially curative treatment

12. Metastatic Cancer to the Liver
Most common origin is colon and rectal cancer (60%)
Most are found incidentally during CT scan A/P
Most centers gives neoadjuvant 2-3 months followed
by surgery
No limit on number of lesions resected
Liver resection ± Radiofrequency ablation

13. Evolution of Liver Surgery
Traditional Liver Surgery Minimally Invasive Robotic/Laparoscopic Liver
Surgery

14. Minimally Invasive Robotic/Laparoscopic Liver Surgery
1. Less postoperative pain
2. Less blood loss
3. Shorter hospital stay
4. Lower perioperative complications & improved recovery
5. Lower wound-related complications (Infection and hernia)
6. Similar oncologic outcomes
7. Better cosmesis

15. Florida Hospital Tampa
The Southeastern Center for Digestive Disorder
Minimally Invasive Robotic and Laparoscopic Liver Surgery Program for Benign and Malignant Liver
Diseases
Call for Referral : (813) 615 – 7030
Office Location : 3000 Medical Park Drive, Suite 500, Lifehope Medical Building, Tampa, FL 33613