Enucleation versus Anatomic Resection for Giant Hepatic Hemangioma: A Meta-Analysis

Abstract

Background: Hepatic hemangiomas are the most common benign liver tumors, and the management of giant hepatic hemangioma (GHH) is still in controversial. The aim of this meta-analysis was to compare the postoperative outcomes of enucleation versus anatomic resection for GHH. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 1988 to December 2015 to identify studies comparing the outcomes of enucleation versus anatomic resection for GHH. Finally, we performed this meta-analysis using the Review Manager 5.3 software, and the results were presented as risk ratio (RR) or mean difference (MD) with corresponding 95% confidence interval (CI). The major limitation is that all data were derived from nonrandomized studies, and we cannot exclude potential selection bias. Results: Nine studies involving 1,185 patients were included. The results showed that there was a lower incidence of complications (RR = 0.66, 95% CI 0.52 to 0.84, I² = 0%, p = 0.0007); no incidents of death occurred among the 9 included trials. Blood loss (MD = -419.07 mL, 95% CI -575.04 to -263.09, I² = 83%, p < 0.00001), duration of surgery (MD = -23.5 min, 95% CI -45.28 to -1.74, I² = 0%, p = 0.03), and length of hospital stay (MD = -1.59 days, 95% CI -3.06 to -0.13, I² = 0%, p = 0.03) were much lower in the enucleation group. Conclusions: GHH can be removed safely by either enucleation or anatomic resection. Enucleation can preserve more hepatic parenchyma and reduce postoperative complications, which is why it should be the preferred surgical procedure for suitable lesions.

Benign Liver Tumors

“…1). In general, the surgical armamentarium consists of liver resection -including hypertrophy concepts like preoperative portal vein embolization, enucleation, hepatic artery ligation, and liver transplantation [27][28][29][30][31][32]. The choice of the procedure depends on HH size, number, and location, the surgeon's experience, and the institutional resources.…”

“…The choice of the procedure depends on HH size, number, and location, the surgeon's experience, and the institutional resources. Several studies comparing enucleation with resection showed that enucleation is associated with lower morbidity, shorter operation time, less blood loss, and fewer complications [28,29]. Furthermore, enucleation can preserve more hepatic parenchyma [28].…”

“…Several studies comparing enucleation with resection showed that enucleation is associated with lower morbidity, shorter operation time, less blood loss, and fewer complications [28,29]. Furthermore, enucleation can preserve more hepatic parenchyma [28]. However, a single-center study in 86 patients with hemangiomas > 10 cm showed no difference between enucleation and resection regarding operation time, blood loss, complications, and hospital stay [33].…”

Giant Cavernous Hemangioma of the Liver in a Patient with Autosomal Dominant Polycystic Kidney Disease

“…Transarterial embolization sometimes is effective in controlling symptoms [ 22 , 23 ], but if it proves to be insufficient, surgery (enucleation or hepatic resection) can be performed. Alternatively, surgery can be considered in the first place [ 24 ]. Preoperative transcatheter arterial embolization can be used preoperatively to alleviate symptoms.…”

Therapeutic Options of Giant Liver Hemangioma

“…According to advances made in liver surgery, enucleation meets the requirement of precise liver surgery which is precision, minimal invasiveness, and effectiveness [21]. Results of recent meta-analyses comparing outcomes of enucleation versus those of anatomic resection for giant liver hemangioma revealed no surgery-related death in both enucleation and resection, however, enucleation was associated with significantly lower blood loss, lower operative time, and lower risk of complications [38,39]. Most authors advocated enucleation because it is safer and quicker with lower overall complications and less blood loss [18,29,33,[40][41][42].…”