Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan.

Abstract

Surgical indications for liver hemangioma remain unclear. Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5-10 cm (n = 164, 32%), Group C 10-15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5-10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.