Nonoperative Management of Hepatic Adenomas: A Review

Hepatic adenomas (HAs) are relatively common benign liver tumors that carry small risks of hemorrhage and malignant transformation, both of which increase with tumor size. While traditionally linked to estrogen-containing oral contraceptives (OCPs), other risk factors including obesity have been associated with HA formation and growth. Treatment strategies depend on the risk of malignant transformation or hemorrhage, tumor size, histological subtype, and patient-specific factors. While traditionally, surgical resection has been the standard recommendation for large, symptomatic, or high-risk tumors, several non-operative strategies are now available to minimize morbidity and optimize outcomes. Active surveillance is recommended for patients with small (< 5 cm), asymptomatic HAs without other risk factors. Loco-regional therapies, including transarterial embolization and radiofrequency ablation, have been used effectively, particularly for small tumors. Mounting evidence suggests that interventions aimed at weight loss, either through lifestyle modifications or bariatric surgery, are efficacious in reducing HA size. Recent data support expanding non-operative management for even large tumors (> 5 cm), as they can respond to lifestyle interventions. Several subgroups of patients warrant special consideration, such as pregnant patients, males, and patients with hepatic adenomatosis. A personalized, multidisciplinary approach remains essential as non-operative strategies continue to expand along with emerging targeted therapies.