Obesity and metabolic syndrome are increasingly recognised as risk factors for development of hepatocellular adenoma (HCA). The implications of weight loss on HCA regression has not been previously reviewed.
To analyse the effects of surgical and non-surgical weight loss on HCA.
Literature review of full-text articles from PubMed and Scopus, on patients with HCA who underwent surgical or non-surgical weight loss was performed. Only English language articles were included and editorial comments were excluded. Wilcoxon signed-ranks test was used for paired data analysis. Spearman correlation was used for correlation between % excess weight loss (%EWL), number and size of HCA lesions.
Out of four studies, seven patients were included in this review, all of whom were female. The median pre-intervention body mass index (BMI) was 41 kg/m2[39, 47], compared to the post-intervention BMI of 28 kg/m2 [26, 32] (p-value = 0.002). %EWL following intervention positively correlated to reduction in number of HCA lesions (%) post-intervention, with a spearman correlation of 0.78 (p-value 0.04). Similarly, %EWL post-intervention was positively correlated, though not statistically significant, to reduction in lesion size (%), with a spearman correlation of 0.46 (p-value 0.29). All patients who were candidates for liver resection pre-intervention based on lesion size >5cm, avoided liver resection post-intervention following surgical and non-surgical weight loss.
Effective long-term weight loss by surgical and non-surgical methods result in regression of HCAs. Weight loss could avoid major liver resections or decrease the morbidity associated with liver surgery. Bariatric surgery should be considered as an option for management of surgically challenging HCAs in carefully selected obese patients. Multicentre long-term trials, whilst adjusting for cofounding factors, are required to determine the effects of surgical compared to non-surgical weight loss on maintenance of HCA regression.