Elsevier

Surgery

Volume 157, Issue 6, June 2015, Pages 1055-1064
Surgery

Liver
National trends in the use of surgery for benign hepatic tumors in the United States

https://doi.org/10.1016/j.surg.2015.01.015Get rights and content

Background

The widespread use of diagnostic imaging has led to an increase in the incidence and diagnosis of benign liver tumors. The objective of this study was to define the overall use and temporal trends of operative procedures for benign liver tumors using a nationally representative cohort.

Methods

All patients who underwent liver surgery for benign liver tumors between 2000 and 2011 were identified from the Nationwide Inpatient Sample database. Trends in annual volume of liver procedures were analyzed using the average annual percent change (AAPC) assessed by joinpoint analysis.

Results

There were 2,489 open (94.5%) and 144 (5.5%) minimally invasive surgical (MIS) procedures. Partial hepatectomy accounted for 43.8% of all cases (n = 1,153). Surgery for patients with benign liver tumors increased from 156 in 2000 to 272 in 2011 (AAPC, 5.8%; 95% CI, 3.2–8.6%). There was decline in the relative use of open operative procedures from 98.1% in 2000 to 92.3% in 2011 (AAPC, −0.4%; 95% CI, −0.7 to −0.1%). In contrast, the proportion of MIS procedures increased from 1.9% in 2000 to 7.7% in 2011 (AAPC, 7.4%; 95% CI, 1.9–13.3%). The median duration of stay among all patients was 5 days (interquartile range, 4–7; 5 days [open] vs 3 days [MIS]; P < .001). Inpatient mortality was 0.6% (n = 15 [open] vs n = 0 [MIS]; P = .43) and did not change during the study period (P > .05).

Conclusion

Overall volume of surgical management of benign liver tumors has increased substantially over the past decade. There has been a relative shift away from open procedures toward MIS procedures.

Section snippets

Data sources and samples

We conducted a retrospective analysis using the NIS database to examine the utilization of surgery for benign liver tumors between January 2001 and December 2011. The NIS database is maintained by the Agency for Healthcare Research and Quality as part of the Healthcare Cost and Utilization Project (HCUP) that contains deidentified data on patients enrolled in Medicare, Medicaid, private insurances, and the uninsured. NIS is the largest publicly available all-payer inpatient care database in the

Patient and hospital characteristics from 2000 to 2011

During the 12-year period, a total of 2,633 hepatic procedures were performed for benign liver tumors. The characteristics of the patients and hospitals are shown in Table I. Median age of the study population was 45 years (IQR, 35–56) and 82.3% (n = 2,157) of patients were female. The majority of patients were Caucasian (n = 1,542; 73.7%). Although patient age and race were similar across time periods in the study cohort, there was an increase in the proportion of female patients (P = .04).

Discussion

Benign liver tumors are common lesions that may be present in up to 20% of the population at autopsy.6, 30 With the expanding use of abdominal imaging, benign liver tumors are being identified increasingly31 and continue to represent a management challenge.22 Benign liver tumors are classified into solid or cystic tumors according to features on radiographic imaging.1 The most common solid benign liver tumors include hemangiomas, focal nodular hyperplasia, and hepatic adenoma, whereas simple

References (55)

  • A. Singhal et al.

    Laparoscopic liver resection for benign and malignant liver tumors

    Hepatobiliary Pancreat Dis Int

    (2011)
  • A. Ejaz et al.

    A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample

    Surgery

    (2014)
  • R.C. Semelka et al.

    Hepatic hemangiomas

    Magn Reson Imaging Clin N Am

    (1997)
  • D.R. Martin et al.

    Imaging of benign and malignant focal liver lesions

    Magn Reson Imaging Clin N Am

    (2001)
  • M. Rodriguez-Pelaez et al.

    Benign liver tumors

    Gastroenterol Hepatol

    (2010)
  • J.F. Gibbs et al.

    Contemporary management of benign liver tumors

    Surg Clin North Am

    (2004)
  • S. Dokmak et al.

    A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas

    Gastroenterology

    (2009)
  • J.J. Mezhir et al.

    Changes in the management of benign liver tumours: an analysis of 285 patients

    HPB (Oxford)

    (2013)
  • Y.S. Yoon et al.

    Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass

    J Pediatr Surg

    (2006)
  • J.F. Gigot et al.

    Laparoscopic management of benign liver diseases: where are we?

    HPB (Oxford)

    (2004)
  • A. Cristiano et al.

    Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management

    Updates Surg

    (2014)
  • P.J. Karhunen

    Benign hepatic tumours and tumour like conditions in men

    J Clin Pathol

    (1986)
  • B. Vachha et al.

    Cystic lesions of the liver

    Am J Roentgenol

    (2011)
  • L. Chiche et al.

    Diagnosis and management of benign liver tumors

    Semin Liver Dis

    (2013)
  • M.M. Al-Hawary et al.

    Imaging of common benign solid liver tumors

    J Med Liban

    (2002)
  • M.M. Al-Hawary et al.

    Imaging of uncommon and rare benign solid liver tumors

    J Med Liban

    (2003)
  • J. Belghiti et al.

    Diagnosis and management of solid benign liver lesions

    Nat Rev Gastroenterol Hepatol

    (2014)
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    Y.K. and N.A. contributed equally to the production of the manuscript.

    Conflict of interest: none.

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