Totally Laparoscopic Resection of an Extremely Giant Hepatic Hemangioma

Veerankutty, Fadl H; Rather, Shiraz Ahmad; Yeldho, Varghese; Zacharia, Bincy M.; Tu, Shabeer Ali; Venugopal, Balaji

doi:10.1055/s-0039-1698520

Cited by 11 publications

(10 citation statements)

References 7 publications

(14 reference statements)

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“…Laparoscopic liver resection is used widely for hepatic hemangioma because it decreases postoperative complications, enables more rapid patient discharge, and supports better postoperative cosmetic satisfaction [ 48 – 52 ]. Laparoscopic resection of even an extremely giant (> 20 cm) hepatic hemangioma has been reported [ 53 ]. However, the results of randomized clinical trials comparing laparoscopic to open liver resection are not yet available, and the learning curve for laparoscopic resection and scoring systems for the degree of its difficulty will continue to evolve [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of surgery for giant hepatic hemangioma

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Outcomes of surgery for giant hepatic hemangioma

et al. 2021

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“…Pre-operative TAE prior to LLR of GHs has only been described in a few case reports [ 7 , 8 , 9 ]. However, given the anecdotal nature of these studies, no consistent information is provided regarding the embolizing materials, limiting the reproducibility of these data.…”

Section: Discussionmentioning

confidence: 99%

“…Some case series of successful laparoscopic liver resections (LLRs) for selected hepatic hemangiomas are currently available in the literature [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ] yet all authors highlight several technical difficulties; high rates of conversion to open surgery and massive intraoperative blood loss are the most challenging. In addition, there is growing evidence that size itself is among the most important risk factors associated with uncontrollable bleeding and limited intrabdominal surgical workspace [ 2 , 13 , 14 ], making LLR a particularly challenging choice for the treatment of GHs exceeding 10 cm.…”

Section: Introductionmentioning

confidence: 99%

The Two-Step Treatment for Giant Hepatic Hemangiomas

Corte

Marino

Ratti

et al. 2021

JCM

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The aim of the present study is to analyze the feasibility and the impact of a two-step approach in the treatment of giant hemangiomas (GH) i.e., exceeding 10 cm in maximum diameter, consisting of transarterial embolization (TAE) followed by laparoscopic liver resection (LLR). Ten patients with 11 GH were treated with TAE and subsequent LLR between 2017 and 2020 (Group A). A matched cohort of 10 patients with GH treated with upfront LLR between 2014 and 2017 was identified for comparison (Group B). Data were analyzed regarding intraoperative and postoperative outcomes, including successful completion of LLR, morbidity, and mortality. Successful microparticle embolization of the GH-feeding arteries was performed in all patients in group A. In three cases a liquid embolic agent (Squid-18) was also injected to obtain complete embolization. No complications were observed after TAE. Successful surgery was performed after a mean time interval of 2.2 days from TAE without any case of conversion to laparotomy. Statistically significant differences between group A and group B were found in intraoperative blood loss (250 ± 200 vs. 400 ± 300 mL, p = 0.039), operative time (245 ± 60 vs. 420 ± 60 min, p = 0.027), and length of stay (5 ± 1 vs. 8 ± 2 days, p = 0.046). Our data suggest that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH >10 cm.

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“…There are currently two types of surgical excision, LAP and laparoscopy (23). The excision type is chosen based on the location and diameter of the hepatic hemangioma and the technical proficiency of the hospital (24). Surgical procedures include enucleation of the hemangioma, irregular hepatectomy, segmental or hemihepatectomy, and extended hemihepatectomy (4,25).…”

Section: Discussionmentioning

confidence: 99%

Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study

Tang¹,

Wang²,

Mao³

et al. 2021

Ann Transl Med

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Background: There is currently a lack of consensus regarding the clinical features, diagnosis, treatment indications and options, and risk assessment of hepatic hemangioma patients.Methods: This was a multicenter, real-world study that analyzed a large number of hepatic hemangioma cases in China and included patient data on epidemiology, diagnosis, treatment methods, and outcomes.Results: A total of 5,143 patients hospitalized for hepatic hemangioma were included, of whom 34.42% were male and 65.58% were female. The age distribution was concentrated between 30 and 60 years old, accounting for 87.41% of the patients. Among the hepatic hemangioma patients, 60.8% had only one tumor, with the most common pathological type being cavernous hemangioma (96.07% of cases). The treatment motivations and indications included anxiety, obvious clinical symptoms, rapid tumor growth, unclear diagnoses and acute emergencies. Overall, 41.4% of the patients were treated for psychological reasons, while 30.59% were treated because they presented obvious (primarily nonspecific) clinical symptoms.Hepatic resection was the main therapeutic method and was based on various indications. There were a small number of patients with Kasabach-Merritt syndrome, according to its generally recognized definition.Conclusions: Most patients in this study who were hospitalized for hepatic hemangioma did not meet the indications for requiring treatment. Surveillance is the recommended course of action for definitively diagnosed hepatic hemangioma, and a new classification system is needed to standardize the diagnosis of this condition.

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Totally Laparoscopic Resection of an Extremely Giant Hepatic Hemangioma

Cited by 11 publications

References 7 publications

Outcomes of surgery for giant hepatic hemangioma

Outcomes of surgery for giant hepatic hemangioma

The Two-Step Treatment for Giant Hepatic Hemangiomas

Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study

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