World Journal of Surgery

, Volume 37, Issue 6, pp 1303–1312

Management of Hemangioma of the Liver: Surgical Therapy or Observation?


  • Süleyman Yedibela
    • Department of SurgeryUniversity of Erlangen-Nuremberg
  • Sedat Alibek
    • Department of RadiologyUniversity of Erlangen-Nuremberg
  • Volker Müller
    • Department of SurgeryUniversity of Erlangen-Nuremberg
  • Ünal Aydin
    • Department of SurgeryUniversity of Gaziantep
  • Melanie Langheinrich
    • Department of SurgeryUniversity of Erlangen-Nuremberg
  • Clemens Lohmüller
    • Department of SurgeryUniversity of Erlangen-Nuremberg
  • Werner Hohenberger
    • Department of SurgeryUniversity of Erlangen-Nuremberg
    • Department of SurgeryUniversity of Erlangen-Nuremberg

DOI: 10.1007/s00268-013-1904-1

Cite this article as:
Yedibela, S., Alibek, S., Müller, V. et al. World J Surg (2013) 37: 1303. doi:10.1007/s00268-013-1904-1



Elective surgery for liver hemangioma is controversial. We reviewed long-term outcomes following elective hepatectomy or observation only for symptomatic and asymptomatic liver hemangioma.


All patients (n = 307) with liver hemangioma referred to our hospital for surgical evaluation from January 1988 to December 2009 were identified, and imaging results, tumor characteristics, surgical indication, surgical mode, outcome of observation, clinical and/or postoperative outcome, and adverse events were retrospectively evaluated.


Complete median follow-up for 246 patients was 124 months. Elective surgery was performed in 103 patients (symptomatic [n = 62] and asymptomatic [n = 41]). Postoperative morbidity occurred in 17 % of the patients and was significantly lower in asymptomatic patients (p = 0.002). No perioperative mortality was registered. Surgery relieved complaints in most (88 %) patients. In the observation group (n = 143), 56 % of patients had persistent or new onset of hemangioma-associated symptoms. Major hemangioma-related complications occurred in 12 patients (9 %) during the follow-up period, and 2 patients died after traumatic hemangioma rupture. Overall the rate of adverse events was by trend lower in the surgical group than in the observation group (35 versus 57 %; p = 0.08).


The majority of patients with liver hemangioma can be safely managed by clinical observation. In a subset of patients, especially those with giant hemangioma and/or occurrence of symptoms, surgical treatment could be considered and is justified in high-volume centers.

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© Société Internationale de Chirurgie 2013