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ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
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A new treatment paradigm: should bariatric surgery be offered for hepatocellular adenomas in obese patients? Literature review

Description
BACKGROUND
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. 
 
AIM
To analyse the effects of surgical and non-surgical weight loss on HCA.
 
METHODS
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. 
 
RESULTS
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.
 
CONCLUSION
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. 
Authors
Adrian Fox - Hepatobiliary Surgery, Eastern Health, 8 Arnold street, Box Hill, Victoria 3128, Australia; Monash University Eastern Health Clinical School, 5 Arnold street, Box Hill, Victoria 3128, Australia, Salena Ward - Bariatric Surgery, Eastern Health, 8 Arnold street, Box Hill, Victoria 3128, Australia; Monash University Eastern Health Clinical School, 5 Arnold street, Box Hill, Victoria 3128, Australia, King Tung Cheung - Bariatric Surgery, Eastern Health, 8 Arnold street, Box Hill, Victoria 3128, Australia, Chathri Ratnayake - General Medicine, Eastern Health, 8 Arnold street, Box Hill, Victoria 3128, Australia, and Janindu Goonawardena - Bariatric Surgery, Eastern Health, 8 Arnold street, Box Hill, Victoria 3128, Australia