Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients

BACKGROUND: Liver hemangiomas are rarely large, symptomatic, or presenting atypical imaging\r\npatterns. Surgery is rarely needed; indications and choice of the best technique remain not precisely\r\ndefined.\r\nMETHODS: Features of hemangiomas and surgical indications were assessed in 74 patients (mean\r\nfollow-up 63.2 months). In 40 operated patients, the results of liver resection versus enucleation were\r\ncompared.\r\nRESULTS: Most hemangiomas (60/74, 81.1%) showed no size increment. In 40 operated patients\r\n(40/74, 54.1%) the mean tumor size (11.9 cm, range 2.6–46.0) was larger than in nonoperated patients\r\n(11.9 vs 6.0 cm, P .0002). Surgical indications were specific symptoms, tumor enlargement,\r\nKasabach-Merritt syndrome, and uncertain diagnosis. Mortality (nil), morbidity (10.0%), and transfusion\r\nrate (15.0%) were similar for 28 liver resections versus 12 enucleations; bleeding was more related\r\nto large hemangioma size than to the choice of either technique. Liver ischemia techniques, autotransfusion,\r\nand intraoperative blood salvage reduced the risk of transfusion.\r\nCONCLUSIONS: Surgery is rarely indicated, has a low risk, and has similar results for liver resection\r\nversus enucleation. Risk of bleeding is related more to the large size of the hemangioma than to the type\r\nof surgery (resection or enucleation). In these patients, management, the need for surgery, and the\r\nchoice of technique should be carefully individualized.