• B V van Rosmalen, A J Klompenhouwer, J Jaap de Graeff, M P D Haring, V E de Meijer, L Rifai, S Dokmak, A Rawashdeh, M Abu Hilal, M C de Jong, Dejong C H C CHC Department of Surgery and School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands, M Doukas, R A de Man, IJzermans J N M JNM Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands., O M van Delden, J Verheij, T M van Gulik, and Dutch Benign Liver Tumour Group.
• Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands.
• Br J Surg. 2019 Sep 1; 106 (10): 1362-1371.

BackgroundHepatocellular adenoma (HCA) larger than 5 cm in diameter has an increased risk of haemorrhage and malignant transformation, and is considered an indication for resection. As an alternative to resection, transarterial embolization (TAE) may play a role in prevention of complications of HCA, but its safety and efficacy are largely unknown. The aim of this study was to assess outcomes and postembolization effects of selective TAE in the management of HCA.MethodsThis retrospective, multicentre cohort study included patients aged at least 18 years, diagnosed with HCA and treated with TAE. Patient characteristics, 30-day complications, tumour size before and after TAE, symptoms before and after TAE, and need for secondary interventions were analysed.ResultsOverall, 59 patients with a median age of 33.5 years were included from six centres; 57 of the 59 patients were women. Median tumour size at time of TAE was 76 mm. Six of 59 patients (10 per cent) had a major complication (cyst formation or sepsis), which could be resolved with minimal therapy, but prolonged hospital stay. Thirty-four patients (58 per cent) were symptomatic at presentation. There were no significant differences in symptoms before TAE and symptoms evaluated in the short term (within 3 months) after TAE (P = 0·134). First follow-up imaging was performed a median of 5·5 months after TAE and showed a reduction in size to a median of 48 mm (P < 0·001).ConclusionTAE is safe, can lead to adequate size reduction of HCA and, offers an alternative to resection in selected patients.© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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