Outcomes of surgery for giant hepatic hemangioma

Abstract

Background The surgical indications for liver hemangioma remain unclear. Methods Data from 152 patients with hepatic hemangioma who underwent hepatectomy between 2004 and 2019 were retrospectively reviewed. We analyzed characteristics including tumor size, surgical parameters, and variables associated with Kasabach–Merritt syndrome and compared the outcomes of laparoscopic and open hepatectomy. Here, we describe surgical techniques for giant hepatic hemangioma and report on two meaningful cases. Results Most (63.8%) patients with hepatic hemangioma were asymptomatic. Most (86.4%) tumors from patients with Kasabach–Merritt syndrome were larger than 15 cm. Enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) were performed through open (87.5%) and laparoscopic (12.5%) approaches. Laparoscopic hepatectomy is associated with an operative time, estimated blood loss, and major morbidity and mortality rate similar to those of open hepatectomy, but a shorter length of stay. 3D image reconstruction is an alternative for diagnosis and surgical planning for partial hepatectomy. Conclusion The main indication for surgery is giant (> 10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. For extremely giant hemangiomas, 3D image reconstruction was indispensable. Hepatectomy should be performed by experienced hepatic surgeons.

The surgical outcomes and risk factors of giant hepatic haemangiomas: a single centre experience

“…Many studies have confirmed that hepatectomy and haemangioma enucleation are safe and feasible if the indications are properly controlled [ 2 , 5 , 7 , 9 , 10 ].…”

“…Hepatic haemangiomas larger than 5 cm were previously considered giant hepatic haemangiomas. However, recent studies have suggested that haemangiomas with a diameter greater than 10 cm should be considered giant hepatic haemangiomas [ 2 ], which is more consistent with the tumour characteristics and requirements for clinical diagnosis and treatment [ 3 , 4 ].…”

“…Data comparing the results of different surgical methods are limited, especially for methods involving enucleation with liver resection in haemangiomas larger than 10 cm. In addition, haemorrhage continues to be a major concern during the perioperative period, particularly in haemangiomas larger than 10 cm, due to the risk of dissection and vascular damage [ 2 , 5 ]. Moreover, haemangioma with a diameter ≥ 10 cm is more likely to compress peripheral blood vessels and gastrointestinal organs, resulting in abnormal liver blood flow and gastrointestinal discomfort [ 5 ].…”

Benign Hepatic Tumors and Liver Transplantation: A Literature Review

“…27 Although less invasive techniques, such as transarterial embolization of the feeding artery and radiofrequency ablation, could induce reduction of the size of giant HH, there is also evidence that surgical management is helpful for symptom relief and has low risk of mortality. 28 Orthotopic liver transplant represents an alternative treatment option in selected cases, with excellent outcomes in terms of safety and survival. 29 Given the low numbers of cases reported in the literature, it can be concluded that OLT in this setting constitutes an extremely rare indication.…”

The Two-Step Treatment for Giant Hepatic Hemangiomas

“…Management of patients with giant hemangiomas (GH) exceeding 10 cm in diameter is currently controversial. Despite prophylactic surgical treatment, historically advocated as the standard of care to avoid potentially life-threatening complications [ 3 ], the prevention of rupture alone is not considered a straightforward indication for surgical removal of an asymptomatic lesion [ 4 ], also taking into account potential postoperative complications.…”