Abstract
BackgroundThe surgical indications for liver hemangioma remain unclear.MethodsData 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.ResultsMost (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.ConclusionThe 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.
Highlights
Cavernous hemangioma, which is usually solitary and asymptomatic, is the most common benign tumor of the liver, with a reported prevalence of 3–20% based on autopsy series [1]
Among 22 patients with Kasabach–Merritt syndrome, 86.4% of hepatic hemangiomas were larger than 15 cm
Hepatic hemangiomas were treated by enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) through open (87.5%) and laparoscopic (12.5%) approaches (Table 3)
Summary
Cavernous hemangioma, which is usually solitary and asymptomatic, is the most common benign tumor of the liver, with a reported prevalence of 3–20% based on autopsy series [1]. Giant hepatic hemangioma, which is defined as a tumor larger than 10 cm in diameter, is uncommon and rarely causes symptoms [2]. Giant hepatic hemangioma is present in less than 10% of cases [3]. Treatments for hepatic hemangioma include radiofrequency ablation (RFA), monoclonal antibody therapy, radiation therapy (RT), trans-arterial embolization (TAE), interferon therapy, liver transplantation, and surgical procedures (enucleation and resection). The advantages of RFA for the treatment of hepatic hemangioma include the lack of requirement for a safety margin and the ability to achieve clear shrinkage of the tumor around the ablation zone [7]. The main disadvantage of RFA for hepatic hemangioma is the risk of hemolysis, including hemoglobinuria, hemolytic jaundice, anemia, and even renal damage, esophageal perforation, and thrombosis.
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