Transarterial (chemo-)embolization and lipiodolization for hepatic haemangioma

Abstract

Background Transarterial (chemo-)embolization/lipiodolization (TAE/TAL) might be an attractive minimally invasive alternative to surgery in the treatment of symptomatic hepatic haemangioma. This review assesses the efficacy and safety of TAE/TAL as primary treatment for symptomatic hepatic haemangioma. Methods A systematic search of the literature was performed by two reviewers following the PRISMA guidelines. Cohort studies and case reports were identified; outcomes of cohort studies were reported. The primary efficacy outcome was tumour size before and after TAE/ TAL. Improvement of symptoms and quality of life (QoL) were secondary outcomes; the primary safety outcome was complications. The Downs and Black statement was used for quality assessment. Results Eighteen cohort studies were identified, including 1284 patients. TAE/TAL led to a decrease in tumour size in 1100/1223 (89.9%) patients and to improvement or disappearance of symptoms in 1080/1096 (98.5%) patients. A significant decrease in tumour size from 9.79 ± 0.79 cm to 4.00 ± 1.36 cm (p \ 0.001) was shown. Grade 3 complications occurred in 37/1284 (2.9%) patients. Surgical treatment was necessary in 35/1284 (2.7%) of patients. Conclusion TAE/TAL appears to be a promising and safe treatment to decrease tumour size of hepatic haemangioma. The technique might also provide partial relief of symptoms, although no randomized clinical trials or prospective studies using validated QoL questionnaires are available. TAE/TAL may be considered as a viable alternative to resection.

Extended liver resection including hypertrophy concept with portal venous embolisation for giant haemangioma. Too much surgery?

“…As a non-surgical approach a transarterial chemoembolization (TACE) can be performed to reduce the tumor growth. 3 In our case the haemangioma was giant and symptomatic, therefore surgical therapy was indicated, which was, however, challenging due to size and location.…”

Therapeutic Evaluation and Management Strategy of Transarterial Embolization for Giant Liver Hemangiomas Exceeding 10 cm in Diameter

“…Transarterial embolization (TAE) is increasingly considered as the effective local treatment for hepatic hemangioma HH, having advantages as a minimal invasion, fast postoperative recovery and a low incidence of complications [1][2][3]. However, there are barely sufficient reports applying TAE to the treatment of giant liver hemangiomas (GLH) with a diameter of more than 10 cm.…”

Digital Staging of Hepatic Hemangiomas Reveals Spatial Heterogeneity in Endothelial Cell Composition and Vascular Senescence

“…1 HH diagnosis often occurs incidentally, and the majority of the lesions remain asymptomatic so that resection or intervention may not be required. 2 Still, a minority of HH may progress so that clinical symptoms arise and surgical resection is indicated. 3,4 The evolution and disease stage of HH and its morphological heterogeneity may be a result of a sequence of lesion-specific alterations over time rather than a sign of disease heterogeneity itself, as analogously has been described for infantile hemangioma.…”

“…1 HH diagnosis often occurs incidentally, and the majority of the lesions remain asymptomatic so that resection or intervention may not be required. 2 Still, a minority of HH may progress so that clinical symptoms arise and surgical resection is indicated. 3,4…”