A nationwide assessment of hepatocellular adenoma resection: Indications and pathological discordance

M.P.D. Haring, A.K.E. Elfrink, C.A.J. Oudmaijer, P.C.M. Andel, A. Furumaya, N. de Jong, C.J.J.M. Willems, T. Huits, J.M.L. Sijmons, E.J.T. Belt, K. Bosscha, E.C.J. Consten, M.M.E. Coolsen, P. van Duijvendijk, J.I. Erdmann, P. Gobardhan, R.J. de Haas, T. van Heek, H.D. Lam, W.K.G. LeclercqM.S.L. Liem, H.A. Marsman, G.A. Patijn, T. Terkivatan, B.M. Zonderhuis, I.Q. Molenaar, W.W. te Riele, J. Hagendoorn, A.F.M. Schaapherder, J.N.M. IJzermans, C.I. Buis, J.M. Klaase, K.P. de Jong, V.E. de Meijer*, Dutch Benign Liver Tumor Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs < 50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small (<50 mm) and large (≥50 mm) tumors. Logistic regression analysis was performed on factors influencing change in tumor diagnosis. Out of 222 patients who underwent surgery, 44 (20%) patients had a tumor <50 mm. Median age was 46 (interquartile range [IQR], 33-56) years in patients with small tumors and 37 (IQR, 31-46) years in patients with large tumors (p = 0.016). Patients with small tumors were more frequently men (21% vs. 5%, p = 0.002). Main indications for resection in patients with small tumors were suspicion of (pre)malignancy (55%), (previous) bleeding (14%), and male sex (11%). Patients with large tumors received operations because of tumor size >50 mm (52%), suspicion of (pre)malignancy (28%), and (previous) bleeding (5.1%). No difference was observed in HCA-subtype distribution between small and large tumors. Ninety-six (43%) patients had a postoperative change in diagnosis. Independent risk factors for change in diagnosis were tumor size <50 mm (adjusted odds ratio [aOR], 3.4; p < 0.01), male sex (aOR, 3.7; p = 0.03), and lack of hepatobiliary contrast-enhanced magnetic resonance imaging (CE-MRI) (aOR, 1.8; p = 0.04). Resection for small (suspected) HCAs was mainly indicated by suspicion of (pre)malignancy, whereas for large (suspected) HCAs, tumor size was the most prevalent indication. Male sex, tumor size <50 mm, and lack of hepatobiliary CE-MRI were independent risk factors for postoperative change in tumor diagnosis.

Original languageEnglish
Article numbere2110
Pages (from-to)E2110-E2110
Number of pages12
JournalHepatology communications
Issue number1
Early online date1 Nov 2022
Publication statusPublished - Jan 2023


  • Malignant-transformation
  • Classification
  • Risk-factors
  • Management
  • Diagnosis
  • Outcomes


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