Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis

Abstract

INTRODUCTION Hepatic haemangiomas are the most common benign liver tumours. They can be treated with surgical resection such as enucleation or hepatectomy if necessary. However, controversy remains over the clinical outcome and safety of these two methods. In this study, we performed a comprehensive meta-analysis to compare the efficacy of liver resection with enucleation for giant haemangiomas. METHODS The online databases PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched for relevant original articles. We compared operation time, blood loss, transfusion requirements, inflow occlusion time and postoperative complications between enucleation and hepatectomy. RESULTS Seven controlled clinical trials met the predefined inclusion criteria. Analysis indicated that the enucleation group had significantly shorter operation time (weighted mean difference, WMD -28.22, 95% confidence interval, CI, -54.82 to -1.62), less blood loss (WMD -395.92, 95% CI -521.25 to -270.58) and fewer complications (odds ratio, OR, 0.47, 95 % CI 0.34 to 0.65). There were no significant differences between enucleation and hepatectomy with regard to transfusion requirements (OR 0.61, 95% CI 0.22 to 1.68) and inflow occlusion time (WMD 7.91, 95% CI -5.62 to 21.44). CONCLUSIONS Enucleation has advantages over hepatectomy in relation to operation time, blood loss and complications. Enucleation is a safe and effective treatment for giant hepatic haemangioma.

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].…”

Therapeutic Options of Giant Liver Hemangioma

“…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]. An increase in mini-invasive surgical procedures for liver benign tumors including hemangiomas has been reported in the last two decades [6].…”

Efficacy and factors affecting the choice of enucleation and liver resection for giant hemangioma: a retrospective propensity score-matched study

“…However, some studies found that there was no significant difference in the curative effect or postoperative outcome between the two techniques [ 16 – 18 ]. The characteristics of tumors in the previous studies were quite different [ 12 – 14 , 19 ]. In the studies that supported EN, the mean tumor diameter was about 5 cm, and most of them were smaller than 10 cm [ 12 – 14 ].…”

“…EN was first proposed in 1988 [ 11 ]. Some surgeons think that there are few blood vessels in the interface between HH and liver parenchyma, and it can be bluntly separated along with the interface so the purpose of less bleeding and complete removal of the focus can be achieved, which means EN is simpler and safer than the traditional LR [ 12 – 14 ], especially for HH at special locations, such as tumors near the hepatic hilum [ 15 ]. However, some studies found that there was no significant difference in the curative effect or postoperative outcome between the two techniques [ 16 – 18 ].…”