Giant Liver Hemangioma: Therapy by Enucleation or Liver Resection

Abstract

Hemangioma is the most common primary tumor of the liver. The widespread use of ultrasonography (USG) and computed tomography (CT) has made the diagnosis more common. Although the vast majority of hemangiomas are diagnosed incidentally and are asymptomatic, treatment is still controversial. Surgery is the treatment of choice, especially in giant, symptomatic hemangiomas and uncertainty of diagnosis. Twenty-two patients (median age: 46 years) underwent resection (n = 12) or enucleation (n = 10) for liver hemangioma from 1989 to 2002. The primary indication for surgery was abdominal pain. Ten patients who were treated by enucleation were compared with twelve patients who were treated by liver resection. Mean tumor size was 90 mm with a range of 40-270 mm. There were no statistically significant differences in tumor size, preoperative liver function tests, hemoglobin levels, and platelet counts between the two groups. Operative time was longer in the resection group, and statistically significant the difference was (p = 0.048). Blood transfusion requirement and blood loss during intraoperative period were higher in the resection group (p = 0.025, p = 0.01, respectively). There were three postoperative complications, 1 in the enucleation group (pleural effusion), 2 in the resection group (liver abscess and wound infection). There was no surgery-related mortality in either group. Although most hemangiomas can be removed by enucleation or liver resection with low morbidity and mortality, if the location and number of hemangiomas are appropriate, enucleation is the choice of the therapy. Hospital stay, blood transfusion requirement, and blood loss can be kept minimal by the selection of enucleation.

Efficacy, safety and feasibility of ultrasound‐guided percutaneous microwave ablation for large hepatic hemangioma

“…4,[8][9][10][11][12] In the past decades non-surgical modalities have been investigated for the treatment of the disease, such as transcatheter arterial embolization and radiation therapy. However, only short-term control could be achieved for hepatic hemangiomas.…”

Preoperative Trans-Arterial Embolization and Surgical Resection for Giant Liver Hemangioma: A Multidisciplinary Approach

“…Two common procedures for surgical intervention include enucleation and resection. Until recently, authors reported that enucleation was associated with decreased morbidity, intraoperative bleeding, hospital stay, and operative times [29][30][31][32]. Nevertheless, these studies included few patients with hemangiomas >10cm.…”

Therapeutic Options of Giant Liver Hemangioma

“…When surgery is indicated, hemangioma can be removed by both liver resection and enucleation procedures. The choice between liver resection and enucleation depends mainly on location, number and size tumor, complications, preference and technical skills of surgeon [33,34]. Enucleation is more preferred in peripheral and right-sided located hemangioma.…”

“…Enucleation is more preferred in peripheral and right-sided located hemangioma. Also it is more suitable in case of multiple locations leading to preserve normal liver parenchyma [12,33,34]. Liver anatomic resection is more preferred in centrally located lesion or when lesion is near or compresses large vessels with high risk of bleeding and prolonged operative time [35][36][37].…”

“…However the risk of blood loss and transfusion is more related to hemangioma size and very large lesion (> 20cm) is associated with high risk of operative bleeding. In such condition, liver anatomic resection is the more suitable procedure [33,34]. Complications such as bleeding and rupture occurred during observation constitute an emergency situation, and in such condition liver resection is more preferable to avoid aggravation of a serious situation and to minimize the risk of operative complications [37].…”