Background : Various modalities have been attempted to treat hepatic cysts, including aspiration and sclerotherapy, laparoscopic fenestration, laparoscopic liver resection and liver transplantation. However, there is a significant lack of consensus and guidelines on which treatment should be considered first.

Methods : Data on patient characteristics, preoperative evaluation, operative characteristics, histopathology, and postoperative outcomes were collected for 162 patients diagnosed with hepatic cysts and who underwent surgery at Samsung Medical Center from January 2018 to April 2023.

Results : In terms of surgical methods, laparoscopic surgery accounted for the majority of cases, 155 (95.7%), followed by open surgery, 7 (4.3%), and there were no laparoscopic to open conversions. Regarding the type of cyst intervention, 58 cases (35.8%) were simply unroofing of the liver and 104 cases (64.2%) were hepatectomy. In terms of postoperative outcomes, there were 12 (7.4%) cases of any complication, of which 7 (4.3%) were major complications with Clavien-Dindo classification 3a or higher. There were 3 (1.9%) symptomatic recurrences and 19 (11.7%) recurrences detected only by imaging during follow-up, representing more than 50% of the initial size of the treated lesion. When multivariate analysis was performed on risk factors for recurrence of hepatic cysts, the results showed a statistically significantly fewer recurrences in the hepatectomy group compared to the fenestration-only group. (OR 0.10 [0.02, 0.36], p〈 0.001) There were no significant risk factors for postoperative complications.

Conclusions : Based on these results, laparoscopic hepatectomy can be more favorably considered for treating hepatic cysts in institutions with extensive experience with laparoscopic hepatectomy