Efficacy and factors affecting the choice of enucleation and liver resection for giant hemangioma: a retrospective propensity score-matched study

Mingguang Ju,Wenyan Zhao,Chaoliu Dai,Feng Xu

doi:10.1186/s12893-020-00935-0

Abstract

BackgroundLiver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial. This study aimed to explore the efficacy and the factors affecting the choice of open procedure for HH.MethodsThe data for patients with pathologically confirmed HH who underwent open surgery from April 2014 to August 2020 were analyzed retrospectively. Univariate and multivariate analyses with logistic regression were performed to disclose the factors associated with the choice of EN or LR. Propensity score matching (PSM) analysis was used to compare the efficacy of the two procedures.ResultsA total of 163 and 110 patients were enrolled in the EN and LR groups. Following 1:1 matching by PSM analysis, 66 patients were selected from each group. Centrally located lesions (OR: 0.131, 95% CI 0.070–0.244), tumors size > 12.1 cm (OR: 0.226, 95% CI 0.116–0.439) and multiple tumors (OR: 1.860, 95% CI 1.003–3.449) were independent factors affecting the choice of EN. There was no significant difference in the median operation time (156 vs. 195 min, P = 0.156), median blood loss (200 vs. 220 ml, P = 0.423), blood transfusion rate (33.3% vs. 33.3%, P = 1.000), mean postoperative feeding (3.1 vs. 3.3 d, P = 0.460), mean postoperative hospital stay (9.5 vs. 9.0 d, P = 0.206), or the major complication rates between the two groups.ConclusionsPeripherally located lesions, tumors size ≤ 12.1 cm and multiple tumors were more inclined to receive EN. There was no significant difference in the efficacy of EN or LR.

Highlights

Liver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial
According to the exclusion criteria, 16 patients who underwent both LR and EN, 39 patients who underwent laparoscopic or robotic surgery, 5 patients with severe systemic diseases, 3 patients who received preoperative non-surgical treatment for HH and one patient who was converted from EN to LR were excluded
A solitary tumor was observed in 97 patients (59.5%) and multiple tumors were observed in 66 patients (40.5%)

Summary

Introduction

Liver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial. Small asymptomatic HH (generally < 5 cm) can be followed up without treatment. Some patients with giant HH (≥ 5 cm) may develop clinical symptoms or complications such as abdominal pain, jaundice, nausea, vomiting. A small number of patients may develop Kasabach–Merritt syndrome due to platelet destruction in the hemangioma or spontaneous rupture [3,4,5,6]. Surgical resection is the main treatment strategy for symptomatic giant HH [7,8,9]. The surgical treatment for HH includes open, laparoscopic, or robotic liver resection (LR) and enucleation (EN) [2, 10].

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