Abstract
ObjectiveTo investigate the surgical indication and tactics for liver hemangioma in the caudate lobeMethodsFrom January 1994 to July 2019, 137 patients, including 51 males and 86 females with the average age of 49.2 years old were diagnosed with liver hemangioma in caudate lobe and received treatment at five tertiary referral hospitals. Clinical features, correlations between tumor size and clinical manifestations, treatments, and prognosis were analyzed.ResultsOf the 137 patients identified, 40 (29.20%) patients were asymptomatic, whereas other 94 patients had clinical symptoms mainly presented as upper abdominal discomfort, epigastric distention, upper abdominal dull pain, nausea, and vomiting. Fifteen (93.75%), 18 (39.13%), and 7 (10.45%) patients presented no clinical symptoms among those tumor size was less than 3 cm (D ≤ 3 cm, n = 16), 3 cm < D ≤ 6 cm (n = 46), and 6 cm < D ≤ 9 cm (n = 67), respectively, while all 8 patients with tumor larger than 9 cm were symptomatic. Tumor diameter was obviously associated with the presence of clinical symptoms. In follow-up period, 7 patients in the conservative group (n = 39) received surgery because of tumor growth or symptom appearance. Totally 105 patients received operation including partial resection or isolated complete resection of caudate lobe and caudate lobe resection combined with liver segment resection, right liver resection, or left liver resection. All operations went smoothly, and no severe complications appeared.ConclusionTumor diameter was obviously associated with the presence of clinical symptoms in patients with hemangioma in caudate lobe. Surgical therapy is not recommended for asymptomatic patients and available for patient who has symptoms. Effective surgical strategies should be put into use to reduce operative bleeding.
Highlights
The caudate lobe, situated deeply in the liver, between the hepatic hila and inferior vena cava (IVC), is anatomically special which had made it hardly feasible to operate on it
We collected and reviewed case files of patients diagnosed with liver hemangioma of caudate lobe and treated from January 1994 to July 2019 at five medical centers in China and studied the surgical indication and strategy for liver hemangioma of caudate lobe by analyzing clinical characteristics of the patients
Clinical features (Table 1) Asymptomatic patients (n = 40) were discovered accidentally mainly in routine medical examination or in examinations for other disease, whose diagnosis of liver hemangioma in caudate lobe was determined by enhanced CT scanning
Summary
The caudate lobe, situated deeply in the liver, between the hepatic hila and inferior vena cava (IVC), is anatomically special which had made it hardly feasible to operate on it. According to reports domestic and overseas, in the meantime, isolated or combined caudate lobectomy is mainly the treatment of liver hemangioma, hepatocellular carcinoma (HCC), metastasis liver carcinoma, hilar hepatic cholangiocarcinoma (HCCA), hepatolithiasis in caudate lobe, etc. Among all those hepatobiliary diseases, liver hemangioma in caudate lobe accounts for a large proportion [1]. Little common views have been reached about the standard of surgical indication, risk assessment, and selection of treatments for liver hemangioma to the best of our knowledge [2, 3]. We collected and reviewed case files of patients diagnosed with liver hemangioma of caudate lobe and treated from January 1994 to July 2019 at five medical centers in China and studied the surgical indication and strategy for liver hemangioma of caudate lobe by analyzing clinical characteristics of the patients
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