Treatment Of Hepatic Hemangioma Research Articles

Laparoscopic liver resection or enucleation for giant hepatic hemangioma: how to choose?

Laparoscopic treatment has been increasingly adopted for giant hepatic hemangioma (HH), but the role of liver resection or enucleation remains uncertain. The aim of this study is to compare the laparoscopic resection (LR) with laparoscopic enucleation (LE) for HH, and to provide evidence on how to choose the most suitable approach for HH. A retrospective analysis of HH patients underwent laparoscopic treatment between March 2015 and August 2022 was performed. Perioperative outcomes were compared based on the surgical approaches, and risk factors for increased blood loss was calculated by logistic regression analysis. A total of 127 patients in LR group and 287 patients in LE group were enrolled in this study. The median blood loss (300 vs. 200mL, P < 0.001) was higher in LE group than that in LR group. Independent risk factors for blood loss higher than 400mL were tumor size ≥ 10cm, tumor adjacent to major vessels, tumor occupying right liver or caudate lobe, and the portal phase enhancement ratio (PER) ≥ 38.9%, respectively. Subgroup analysis showed that LR was associated with less blood loss (155 vs. 400mL, P < 0.001) than LE procedure in patients with high PER value. Both LR and LE approaches exhibited similar perioperative outcomes in patients with low PER value. Laparoscopic treatment for HH could be feasibly and safely performed by both LE and LR. For patients with PER higher than 38.9%, the LR approach is recommended.

Interventional treatments for hepatic hemangioma: A state-of-the-art review

Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. Despite significant advances in the development of minimally invasive techniques and their popularization, interventional treatment of HH is still the preferred choice. In the present review, we discuss the pathological properties, type of blood supply, and treatment indications for HH and assess the status and progress of the existing interventional treatments.

Laparoscopic versus open surgery in the treatment of hepatic hemangioma: A meta-analysis.

Background:The aim of this study was to systematically evaluate and compare the effectiveness and safety of laparoscopic versus open resection (LR vs OR) in the treatment of hepatic hemangioma.Methods:We searched PubMed, the Cochrane Library, Web of Science, Medline, EMBASE, and the Chinese Biomedicine Database from January 2000 to April 2020 for studies comparing the outcomes of laparoscopic versus open surgery in hepatic hemangioma treatment.Results:Based on the preset criteria, 12 randomized clinical trials (RCTs) and 12 observational clinical studies (OCSs) were selected for analysis. Our results showed that laparoscopic surgery was more effective than open surgery in terms of reducing operation time, intraoperative blood loss, postoperative exhaust time, postoperative complications, postoperative bile leak, postoperative intra-abdominal infection, postoperative alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values, postoperative visual analog scale (VAS) scores, and hospitalize length. No significant differences were found between the 2 groups in hepatectomy time, hospitalized cost, intra-abdominal hemorrhage, and the postoperative recurrence of hemangioma.Conclusion:While similar therapeutic effect was achieved by the compared herein surgical methods, the findings of our analysis revealed that laparoscopic surgery is superior over open surgery in terms of less trauma, faster recovery, less postoperative pain, shorter hospitalize length, and reduced postoperative complications. Therefore, laparoscopic resection of hepatic hemangioma is a safe, effective, and feasible surgical method that is worth considering in clinical applications.

Diagnosis and Treatment of Hepatic Hemangioma

The clinical manifestations of hepatic hemangioma are not specific. At present, the diagnosis of hepatic hemangioma mainly depends on imaging examination, and the treatments are based on surgery. However, the current indications and timing for surgical treatments and surgical options for hepatic hemangioma remain controversial. This article introduces our current understanding of hepatic hemangioma and the current status of diagnosis and treatment of hepatic hemangioma, providing a basis for the standardization of diagnosis and treatment of hepatic hemangioma. Treatments of hepatic hemangioma include surgery, hepatic artery embolization, radiofrequency ablation, radiation therapy, intraoperative microwave coagulation, cryotherapy, and sclerotherapy. Surgical treatment is the preferred option for patients without surgical contraindications.

Clinical study on laparoscopic cold cycle microwave ablation combined with hepatectomy for the treatment of hepatic hemangioma

Objective To explore the clinical effect and feasibility of cold cycle microwave ablation combined with laparoscopic hepatectomy for hepatic hemangioma. Methods Thirteen cases of hepatic hemangiomas were treated with cold cycle microwave ablation combined with laparoscopic hepatictomy, and their clinical data were analyzed retrospectively from March 2015 to October 2017 in the First People′s Hospital of Jiangxia District of Wuhan City, including 5 males and 8 females with an average age of 52 years and age range of 45-68 years. The course of disease was 18 months to 8 years, with an average of 4.2 years. The clinical data were retrospectively analyzed and the operation time, intraoperative blood loss, postoperative hospital stay, liver function changes and complications were recorded. The data were analyzed using SPSS 17.0 statistical software, and measurement data with normal distribution were expressed as mean±standard deviation (Mean±SD). Results The operations of the 13 cases were successful, including 7 cases of single hepatic hemangioma (the lesions were located in segments Ⅱ, Ⅲ and Ⅳ) and 6 cases of multiple hepatic hemangioma (the lesions were located in segments Ⅱ, Ⅲ, Ⅳ, Ⅶ and Ⅷ). No hepatic portal occlusion was performed during the operation. The operation time was (135.4±35.8) min, intraoperative blood loss was (95.2±22.7) ml, the postoperative hospital stay was (6.4±0.8) d. On the first postoperative day, alanine aminotransferase was (354.2±75.4) IU/L, and aspartate aminotransferase was (382.7±68.5) IU/L, during the first week after surgery, alanine aminotransferase and aspartate aminotransferase both decreased to the normal range, and no serious complications such as bile leakage or hemorrhage occurred after surgery. No recurrence was observed after 6 to 12 months of follow-up. Conclusions Under the premise of strict control of surgical indications, laparoscopic cold-circulation microwave ablation combined with hepatectomy for hepatic hemangioma is safe and feasible. It can simultaneously treat multiple lesions, and cold-cycle microwave ablation can effectively reduce intraoperative bleeding with a minimally invasive effect. Key words: Microwaves; Ablation techniques; Hemangioma; Laparoscopes; Hepatectomy

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Introduction: Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experience of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Method: This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. Result: Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5 – 31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical significant differences between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. Conclusion: Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobeHH,HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time.

Abstract No. 429 A case control study of percutaneous sclerotherapy versus transcatheter hepatic arterial embolization for treatment of large-volume hepatic hemangioma

To evaluate the clinical efficacy of percutaneous sclerotherapy and transcatheter hepatic artery embolization in the treatment of large volume hepatic hemangioma. Twenty-two patiens with large-volume hepatic hemangioma (diameter larger than 5 cm) were randomly divided into two groups between Jan 2015 and Aug 2017 at one single institution. Eleven cases were undergone percutaneous injection of bleomycin sclerotherapy under CT-guidance (sclerotherapy group), 11 patients were performed by DSA-guided bleomycin lipiodol emulsion transcatheter hepatic artery embolization (embolization group). The procedure time, hospital cost, postoperative outcomes, complications and QOL scales were reviewed and analyzed. The mean procedure time (15.6+6.4) min in sclerotherapy group was shorter than that in the embolization group (51.5+7.2) min. The liver dysfunction rate of sclerotherapy group (27.3%, 3/11) was much lower than that in embolization group (90.9%, 10/11). The mean hospitalization and cost of sclerotherapy group were significantly less than that of embolization group, p0.05. At 6 months follow-up post procedure, the effective rate (CR+PR) of sclerotherapy group and embolization group were (81.8%, 9/11), (92.3%, 10/11), respectively, p>0.05. Both approaches (sclerotherapy, embolization) in the treatment of large-volume hepatic hemangioma are effective and safe. Sclertotherapy is more simple, cost-effective method in the treatment of hepatic hemangioma.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts.

Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

Analysis of value of laparoscopic hepatectomy in the treatment of hepatic hemangioma

Objective To explore the clinical value of laparoscopic hepatectomy for the treatment of hepatic hemangioma. Methods Clinical data of forty-six patients treated with hepatic hemangioma hepatectomy in Dongfeng Hospital Affiliated to Hubei University of Medicine from February 2014 to February 2017 were collected.The patients were divided into the laparoscopic hepatectomy group (LH group 26 cases) and the open hepatectomy (OH group 20 cases) by retrospective descriptive study.The operation time, hepatectomy time, intraoperative blood loss, postoperative complications, postoperative liver function recovery time, hospitalization time, total hospitalization cost, number of residual tumor tissues and follow-up recurrence rate of the two groups were compared. Results The length of incision in the laparoscopic hepatectomy group was significantly lower than that in the open hepatectomy group ( (5.41±0.53) cm vs.(19.72±1.26) cm, t=52.335, P=0.000), the intraoperative blood loss, operation time, exhaust time, indwelling drainage time, first postoperative feeding time and postoperative hospitalization time in the LH group were significantly lower than those in the OH group ((572.23±16.92) ml vs.(911.75±19.41) ml, (149.52±18.14) min vs.(171.47±21.35) min, (2.84±0.63) d vs.(3.46±0.57) d, (5.74±3.380) d vs.(10.62±3.59) d, (2.08±0.52) d vs.(3.10±0.61) d, (8.91±2.16) d vs.(14.84±2.09) d, t=63.287, 3.767, 3.447, 4.725, 6.117, 9.360, P<0.05); in the LH group, liver function recovery index alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower than those in the OH group ( (45.73±2.16) U / L) vs.(149.29±3.44) U/L, (47.32±1.89) U/L vs.(50.60±3.53) U / L, t=124.985, 4.051, P<0.05). Conclusion Laparoscopic hepatectomy for patients with hepatic hemangioma is characterized by less trauma, quicker recovery and higher safety. Key words: Laparoscopy; Hepatic tumor; Application value

Intratumoral coagulation by radiofrequency ablation facilitated the laparoscopic resection of giant hepatic hemangioma: a surgical technique report of two cases.

BackgroundTraditionally, open hepatic resection is the first choice of treatment for symptomatic enlarging hepatic hemangiomas, which requires a large abdominal incision and is associated with substantial recovery time and morbidity. Minimally invasive laparoscopic resection has been used recently in liver surgery for treating selected hepatic hemangiomas. However, laparoscopic liver surgery poses the significant technical challenges and high rate of conversion. Radiofrequency (RF) ablation has been proved feasible in the treatment of hepatic hemangiomas with a size range of 5.0-9.9 cm. It is controversial to treat giant hepatic hemangiomas (≥10.0 cm) by means of RF ablation, due to the low technique success rate and high incidence of ablation-related complications. We aimed to assess the safety and efficacy of combined laparoscopic resection with intratumoral RF-induced coagulation for giant hepatic hemangiomas.MethodsWe treated 2 patients with giant subcapsular hepatic hemangioma (12.0 cm and 13.1 cm in diameters respectively) by laparoscopic resection following intratumoral coagulation of the tumor with RF ablation.ResultsBlood loss during resection was 100 ml (case 1) and 300ml (case 2) respectively. No blood transfusion and dialysis were needed during perioperative period. The two patients were discharged 6 days (case 1) and 12 days (case 2) after surgery without any complications, respectively. Postoperative contrast-enhanced CT follow up showed there was no residual tumor.ConclusionsIt is feasible to treat giant subcapsular hepatic hemangioma by laparoscopic tumor resection boosted by intratumoral coagulation using RF ablation, which may open a new avenue for treating giant hemangioma.

Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma.

Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the “early leaving but late returning, hanging nut on a twig” sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05), but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05), and the patients’ condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma.

Comparison of the clinical effect of laparoscopic partial hepatectomy and open surgery in treatment of hepatic hemangioma

Objective To investigate the efficacy of laparoscopic partial hepatectomy and open surgery in the treatment of hepatic hemangioma.Methods The clinical data of 45 cases of laparoscopic partial hepatectomy and 15cases of open surgery were retrospectively analyzed.The incision length,operative time,blood loss,start eating timeafter operation,postoperative drainage volume,postoperative hospital stay and incidence rate of complications werecompared between the two groups.Results The incision length,blood loss,start eating time after operation,postoperative drainage volume,postoperative hospital stay of laparoscopic partial hepatectomy group were [(4.5 ± 1.1) cm,(100.3 ± 33.7) ml,(1.5 ± 0.4) d,(112.2 ± 32.7) ml,(6.7 ± 1.5) d],which were better than those in the opensurgery group[(25.1 ±5.4)cm,(201.5 ±23.8)ml,(3.5 ±0.6)d,(230.3 ±43.7)ml,(11.3 ± 3.7)d],the differences were statistically significant between the two groups (t =1.977,2.023,1.989,2.015,2.025,P ＜ 0.05).The operation time of the open surgery group was (159.4 ± 20.5) min),that in laparoscopic partial hepatectomy group was (139.0 ± 21.7) min,the difference was not statistically significant (t =1.453,P ＞ 0.05).The incidence rate of complications in laparoscopic partial hepatectomy group was significantly lower than the open surgery group(x2 =3.013,P ＜ 0.05).Conclusion Compared with open surgery,laparoscopic partial hepatectomy has the advantages of less blood loss,faster recovery,and fewer complications in the treatment of hepatic hemangioma. Key words: Hepatic hemangioma; Laparoscopy; Hepatectomy

The clinical effectiveness of laparoscopic treatment of hepatic hemangioma

Objective To evaluate the feasibility and efficacy of laparoscopic treatment of hepatic hemangioma. Methods The clinical data of 27 patients who received laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 were retrospectively analyzed. The hepatic inflow to the liver or to a hemiliver was temporarily blocked using a Pringle manoeuvre with a self-invented laparoscopic blocker at the porta hepatis or at the pedicle to the relevant hemiliver. The Electriccautery and ultracision were used for liver transaction. Results Laparoscopic treatment of hepatic hemangioma was successfully performed in 25 patients. Conversion to laparotomy was required in two (8%) patients for uncontrollable bleeding. There were no major postoperative complications and no mortality. The mean tumor diameter was (6.34±2. 17) cm. The operating time was ( 105.21 ±72.76)min. The time of hepatic inflow block was (10. 17±12. 21)min. The blood loss was (115. 5±212.14)ml. The volume of blood transfusion was (0. 87 ± 1.45)U. The volume of postoperative drainage was (112.60±201.03)ml. The time taken to return to normal activity was (2. 0±0. 8) days.The length of postoperative hospital stay was (5.5±2.4) days. The length of total hospital stay was (12. 5 ±5.3) days. The total cost was RMB10041.6±8678. 7. Conclusion In selected patients, laparoscopic treatment of hepatic hemangioma was safe and feasible. Key words: Laparoscopes; Hepatectomy; Hemangioma

One case of massive necrosis of right liver lobe after interventional treatment of hepatic hemangioma

One case of massive necrosis of right liver lobe after interventional treatment of hepatic hemangioma

Surgical treatment of hepatic hemangiomas: A personal experience

Surgical treatment of hepatic hemangiomas: A personal experience

Spontaneous rupture of liver hemangioma: Risk factors for rupture

We report a case of spontaneous rupture of a giant cavernous hemangioma of the liver arising from the caudate lobe, with extrahepatic growth, in a 67-year-old man. At emergency laparotomy, partial resection of the caudate lobe was performed and the hemangioma was found to measure 13 ×12×8 cm. The patient had a 10-year history of severe asthma requiring steroid therapy. To investigate the risk factors for spontaneous rupture of hepatic hemangioma, we compared the characteristics of patients with ruptured and non-ruptured lesions showing extrahepatic growth reported in the Japanese literature. Lesions with a diameter ≥4 cm located on the surface of the liver or showing extrahepatic growth appear to have a high risk of spontaneous rupture if the patient receives steroid therapy for a coexisting disorder. Even in patients who have not received steroid therapy, hemangiomas≥7–8 cm in diameter located in the left lobe with extrahepatic growth may also have a high risk of rupture. The treatment of hepatic hemangioma should be decided on the basis of the size and the location, and on the requirement for steroid therapy.