Management and follow-up of 78 giant haemangiomas of the liver

Abstract

The natural history and appropriate treatment of giant liver haemangioma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered into a follow-up programme consisting of clinical assessment and abdominal ultrasonography every 6 months. Resection was considered only for symptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean follow-up was 36 months for the resected patients and 55 months for the observed group. Surgery permanently relieved symptoms. No recurrence of haemangioma was observed. Some 32 of 36 unresected lesions followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a further indication for resection and justifies strict imaging follow-up. The pattern of growth, rather than absolute size, of a lesion is suggested for selection of asymptomatic patients who might benefit from preventive surgical excision. When feasible, the authors prefer enucleation to remove giant haemangiomas.

Experience with Surgical Resection of Giant Hepatic Hemangiomas

“…In a large series of patients from Italy, out of 78 lesions, 16 were resected and 62 were followed up with six-monthly ultrasound for up to 55 months, and none of the lesions ruptured or became symptomatic. 4 In a Japanese series of 20 patients with small hemangioma, follow-up for up to eight years failed to indicate symptoms or significant increase in size. 5 In a study from Germany, out of 238 patients with hemangioma, 143 patients had resection and the rest were followed up for a median period of 32 months.…”

“…It seems that the best approach for asymptomatic giant hemangioma is regular follow-up, and that the rate of increase in the size of a hemangioma is more important than the original size to start with in terms of the chances of complications. 4 It is also vital not to attribute symptoms of other pathologies to the incidental finding of a hemangioma, when investigations are being done for that particular pathology. Obviously, resecting the hemangioma will not relieve these symptoms, thereby exposing the patient to an unnecessary major surgical procedure.…”

“…Simple enucleating has been reported to be safe without major blood loss. 4,9 Surgical resection is the treatment of choice for a giant symptomatic hemangioma, and if it is unresectable, then liver transplantation may be considered. 10 Our experience indicates that resection of giant hemangioma of the liver is safe.…”

Hemangioma hepático gigante asociado a síndrome de Kasabach-Merrit

“…La mayoría de los pacientes permanece estable a lo largo del tiempo (4,8,9). Únicamente se aprecia un aumento de tamaño de forma ocasional, llegando a requerir resección quirúrgica (10)(11)(12). La ruptura espontánea es rara incluso en hemangiomas gigantes.…”

Therapeutic Options of Giant Liver Hemangioma

“…Conservative approach is justified even in very large hemangiomas and tumour size alone is not supported as an indication for urgery [12][13][14][15][16][17]. Thus, asymptomatic and non-complicated giant liver hemangioma can be safely observed by supervision through regular imaging control with lower risk of adverse events [2,[15][16][17][18][19][20][21].…”