Focal nodular hyperplasia: are the existing surgical indications sufficient?

Background: Focal nodular hyperplasia (FNH) is a benign liver tumor. The surgical indication of benign liver tumors has expanded due to the minimally invasive surgery (MIS) trend. Whether the tumor located in a specific location (such as under capsule, caudate lobe, left lateral lobe, etc.) or with psychological disorders can be used as an indication for surgery is rarely reported.This study explores the feasibility and safety of laparoscopic liver resection and provides potential surgical indications for FNH. Methods: : A retrospective analysis of 29 FNH patients treated surgically at the First Affiliated Hospital of Soochow University from 2013 to 2021, with a median follow-up of 12 months. Data analysis included perioperative indication, mortalities, and prognosis. Results: : All patients had surgery for FNH after pathology confirmed the diagnosis. The tumor's mean diameter was 5.5 cm (±1.8 cm). Laparoscopic liver resection was performed on 23 patients. Among them, five patients underwent right posterior lobe resection, and nine received robot-assisted laparoscopic lobectomy. one patient developed subdiaphragmatic fluid and required drainage. The anxiety and depression of all patients have been alleviated compared to the preoperative data(SCL-90).No patients had tumor recurrence or adverse outcomes related to liver resection during the follow-up period. Conclusion: Laparoscopic resection of FNH can be performed with few complications and a short retrieval length using reliable laparoscopic technology and skills. Surgical therapy for FNH is a safe procedure with low morbidity and an excellent prognosis.Resection can be an option for FNH patients with severe psychological problems or specific tumor location.