Abstract
The management of symptomatic giant hepatic hemangiomas (> 10 cm) varies in the literature. Multiple interventional approaches have been described including surveillance, embolization, enucleation, and resection based on tumor size, location, relationship to vascular and biliary structures, and the quality and quantity of the functional liver remnant. Resection is often performed as a last resort due to the risk of major hemorrhage. Preoperative arterial embolization is an option; however, many patients will experience severe pain, fever, transaminitis, acidosis, recanalization, and collateral inflow that limit its utility. Furthermore, patients require post-procedure inpatient observation, and there is no consensus on the appropriate time interval between procedures. We present and demonstrate a technique in the video that utilizes a hybrid operating room with on-table angiogram capabilities to perform hemangioma inflow embolization and immediate hepatic resection under the same anesthesia in a single procedure. Combining on-table embolization with immediate resection avoids many of the pitfalls of preoperative embolization, while enhancing the safety of the resection by decreasing the size of the tumor, enabling compressibility, and facilitating exposure of the vascular inflow and outflow. It is an efficient use of hospital resources and eliminates an intervening hospital admission. We have found it to be a preferred approach to enhance the safety and feasibility of resection for massive hepatic hemangiomas with minimal intraoperative blood loss and reduced risk.
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The study was conceived by AVM, and data collected, procedure performed, and video/submission drafted by AVM, DAR, and NP.
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The authors have no conflicts or disclosures. Presented at the Americas Hepatopancreatobiliary Association 2020, Miami, FL. Funded in part by the National Institutes of Health K08CA190855
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Maker, A.V., Al Rameni, D. & Prabhakar, N. Combining On-Table Embolization with Immediate Resection to Safely Excise Giant Hepatic Hemangiomas. J Gastrointest Surg 25, 1651–1653 (2021). https://doi.org/10.1007/s11605-021-04957-8
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DOI: https://doi.org/10.1007/s11605-021-04957-8