Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Wahab, Mohamed Abdel; Nakeeb, Ayman El; Ali, Mahmoud Abdelwahab; Mahdy, Youssef; Shehta, Ahmed; Abdulrazek, Mohamed; Desoky, Mohamed El; Wahab, Rihame Abdel

doi:10.1007/s11605-018-3696-y

Cited by 38 publications

(17 citation statements)

References 31 publications

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“…During the preliminary search, 132 articles were obtained. After reading the titles and abstracts and full texts and removing duplicate documents, a final number of 12 articles ( 8 , 12 – 22 ) were included in our study, which involved 1,384 patients ( Figure 1 ). Among them, 726 underwent pure hemangiomas enucleation and 658 were operated through hepatectomy.…”

Section: Resultsmentioning

confidence: 99%

“…There are various treatment methods such as hemangioma enucleation, hepatectomy, hepatic artery interventional embolization, radiofrequency ablation, and others ( 6 , 7 ). When there are surgical indications such as large tumors, liver resection or hemangioma enucleation is the first choice of treatment ( 8 ). Hepatectomy is the traditional surgery for the treatment of hepatic hemangioma, but this surgery may be more traumatic than others because of the excessive removal of normal liver tissues, inaccurate treatment of liver sections, and a large amount of blood leakage.…”

Section: Introductionmentioning

confidence: 99%

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Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis

et al. 2022

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ObjectiveTo compare the safety and efficacy of enucleation and hepatectomy for the treatment of hepatic hemangioma (HH).MethodsA systematic literature search was conducted to identify studies evaluating enucleation versus hepatectomy for HH starting from the time of database creation to February 2022. Extraction of the data used in this study was done from the literature. The differences between the two surgical approaches were evaluated by comparing and analyzing the relevant data by means of meta-analysis.ResultsA total of 1,384 patients (726 underwent enucleation, and 658 with hepatectomy) were included in our meta-analysis from 12 studies. Enucleations were associated with favorable outcomes in terms of operation time [mean difference (MD): −39.76, 95% confidence interval (CI): −46.23, −33.30], blood loss (MD: −300.42, 95% CI: −385.64, −215.19), length of hospital stay (MD: −2.33, 95% CI: −3.22, −1.44), and postoperative complications (OR: 0.57, 95% CI: 0.44–0.74). There were no differences between the groups in terms of patients needing transfusion (OR: 0.85, 95% CI: 0.50, 1.42), inflow occlusion time (MD: 1.72, 95% CI: −0.27, 3.71), and 30-day postoperative mortality (OR: 0.23, 95% CI: 0.02–2.17).ConclusionCompared with hepatectomy, enucleation is found to be effective at reducing postoperative complications, blood loss, and operation time and shortening the length of hospital stay. Enucleation is similar to hepatectomy in terms of inflow occlusion time, 30-day postoperative mortality, and patients needing transfusing to hepatectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis

et al. 2022

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

Section: Methodsmentioning

confidence: 99%

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

et al. 2022

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Objective To evaluate the safety of performing surgery on cavernous haemangiomas in the liver larger than 10 cm and establish preoperative predictors of intraoperative blood transfusion and morbidity. Methods A total of 373 patients with haemangiomas larger than 10 cm who underwent surgery in our hospital were retrospectively analysed. According to tumour diameter, the patients were divided into a giant haemangioma (GH) group (241 cases) (10 cm ≤ diameter < 15 cm) and an enormous haemangioma (EH) group (132 cases) (diameter ≥ 15 cm). Clinical parameters were then compared between the two groups. Results Compared with the GH group, the EH group had higher rates of leukopenia (10.6% vs. 4.5%), anaemia (26.5% vs. 15.7%), and thrombocytopenia (13.6% vs. 6.2%). The occlusion time in the EH group was longer than that in the GH group (26.33 ± 14.10 min vs. 31.85 ± 20.09 min, P < 0.01). The blood loss and blood transfusion in the EH group were greater than those in the GH group (P < 0.05). Moreover, the morbidity in the EH group was higher than that in the GH group (17.4% vs. 9.13%, P < 0.05). According to the results of the multivariable analysis, the operation time and size of the haemangioma may be independent risk factors for blood transfusion (P < 0.05). Additionally, the size of the haemangioma may be an independent risk factor associated with complications (P < 0.05). Conclusion Enormous haemangioma is more likely to cause haematologic abnormalities than giant hepatic haemangioma. The risks of the operation and postoperative complications of enormous haemangioma are higher than those of giant hepatic haemangioma.

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“… 3 , 4 Surgery is the most effective and widely accepted treatment for these symptomatic HH patients. 5 Rapid progress has continued in the technology and instrumentation 6 of laparoscopic surgery, which is mirrored by increasing acceptance by patients with HH, 7 even giant HH (defined here at >10 cm in diameter), 8 , 9 to undergo surgical resection with this technique. Nevertheless, certain obstacles remain problematic specifically relating to laparoscopic surgery for HH, 7 the most common and critical of which is potentially severe intraoperative bleeding that often results in conversion to laparotomy.…”

Section: Introductionmentioning

confidence: 99%

Location of Hemangioma is an Individual Risk Factor for Massive Bleeding in Laparoscopic Hepatectomy

Liu

Huang

et al. 2021

JSLS

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Background and Objectives: The scope of laparoscopic surgery has expanded to encompass hepatic resections, specifically hepatic hemangioma. The most serious intraoperative complication is bleeding, often requiring laparotomy. Because risk factors associated with such massive blood loss have not been well evaluated, the intent of this retrospective study was to analyze these risk factors associated with laparoscopic resection of hepatic hemangiomas. Methods: From June 1, 2011 to January 31, 2021, 140 consecutive patients underwent laparoscopic surgery for hepatic hemangioma in our hospital. According to quantity of intraoperative blood loss, they were divided into massive (≥ 800 ml) and minor blood loss (< 800 ml) groups. Perioperative data were analyzed by univariate and multivariate analyses with logistic regression to identify the risk factors for potential massive blood loss during laparoscopic resection. Results: There were 24 and 116 patients in the massive and minor blood loss groups, respectively. Of four risk factors significantly associated with massive blood loss by univariate logistic regression analysis (location of hemangioma in the liver, postcaval or hepatic venous compression, hilar compression, and body mass index exceeding 28) the multifactorial logistic model identified only location in the liver of the hemangioma as statistically (P = 0.012) associated with intraoperative massive blood loss. Conclusions: Location of the hepatic hemangioma was the single statistically significant risk factor for massive blood loss during laparoscopic surgery for hepatic hemangioma. Of particular importance, location in Couinaud liver segments I, IVa, VII, and VIII necessitates precautions to mitigate the risk of massive blood loss.

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Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Cited by 38 publications

References 31 publications

Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis

Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis

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

Location of Hemangioma is an Individual Risk Factor for Massive Bleeding in Laparoscopic Hepatectomy

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