Treatment of Polycystic Liver Disease: One Size Does Not Fit All

(A) Deep-seated large cyst in the right hepatic lobe, approachable (at a lower level to avoid the lung) for cyst aspiration and alcohol sclerosis. (B) Superficial large cyst arising from the right lobe of the liver suited for laparoscopic fenestration. (C) Polycystic liver disease (PLD) involving both lobes, more severely segments VII and VIII; this patient is not a good candidate for combined liver resection and cyst fenestration because of the distribution of the cysts and involvement of the less severely affected segments by many small cysts with further potential for growth. This patient might benefit from embolization of hepatic artery branches supplying segments VII and VIII that have no recognizable hepatic parenchyma. (D and E) PLD before (D) and after (E) combined right lobectomy and cyst fenestration; note compensatory hypertrophy of the left lobe after surgery. (F) Massive PLD without relative preservation of any liver segment; the only feasible treatment in this patient is liver transplantation.