World Journal of Surgery

, Volume 19, Issue 1, pp 19–24 | Cite as

Cavernous hemangiomas of the liver: Are there any indications for resection

  • Olivier Farges
  • Salam Daradkeh
  • Henri Bismuth

Abstract

A total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio-computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty-seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n=8), embolization (n=5), or hepatic artery ligation (n=1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty-five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.

Résumé

Cent soíxante trois patients ayant un hémangiome caverneux du foie ont été observés à l'Hôpital Paul Brousse entre 1970 et 1992. La tumeur était inférieure à 4 cm de diamètre chez 54 patients et supérieure à 10 cm chez 38. La sensibilité de l'imagerie a été de 61% pour l'échographie, de 77% pour la tomodensitométrie avec injection, de 85% pour l'angiographie, et de 92% pour la résonance magnétique nucléaire. Le diagnostic de la tumeur a été fait par le bilan d'une douleur abdominale chez 87 patients. Quarante sept patients avaient des désordres associés qui étaient, en fait, responsable de la symptomatologic. Quatorze patients avec des symptômes particulièrement gênants ont été traités de façon spécifique: résection (8), embolisation (5), ligature de l'artère hépatique (1). Sept de ces patients sont toujours symptomatiques témoignant qu'en fait l'hémangiome n'étaient pas responsable de leurs symptômes. Vingt-cinq patients avaient cu des antalgiques per os. Les symptômes ont repris ou ont diminué en fréquence chez 21 patients. Un hémangiome non réséqué n'a jamais augmenté de volume, ne s'est jamais compliqué ou est devenu symptomatique. Ces résultats semblent démontrer que la résection est rarement indiquée dans l'hémangiome du foie et les indications doivent tenir compte des risques de la chirurgie hépatique.

Resumen

Ciento sesenta y tres pacientes con hemangiomas cavernosos del hígado han sido manejados en el Hospital Paul Brousse entre 1970 y 1992. En 54 pacientes el tumor tenía un diámetro menor de 4cm y en 38 un diámetro mayor de 10cm. La sensibilidad de los procedimientos de imagenología fue: ultrasonido, 61%; angio-TAC, 77%; angiografía, 85%; resonancia magnética, 92%; el tumor fue diagnosticado en el curso de una evaluación por dolor abdominal en 87 pacientes, de los cuales 47 presentaban alteraciones asociadas que probaron ser causa de los síntomas. Catorce pacientes con síntomas incapacitantes fueron sometidos a tratamiento específico de su tumor: resección (8), embolización (5), ligadura de la arteria hepática (1); 7 de estos pacientes están todavía sintomáticos, lo cual indica que su hemangioma en realidad no era responsable de la sintomatología. Veinticinco pacientes recibieron medicación antiálgica oral; los síntomas reaparecieron o se han hecho infrecuentes en 21. Los hemangiomas no resecados no aumentaron significativamente en su tamaño, no se han complicado ni se han vuelto sintomáticos. Estos resultados indican que la resección de los hemangiomas del hígado es raramente necesaria y que emprenderla sólo debe hacerse luego de sopesar su ventaja contra el riesgo inherente de una operación hepática.

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Copyright information

© Société Internationale de Chirurgie 1995

Authors and Affiliations

  • Olivier Farges
    • 1
    • 2
    • 3
  • Salam Daradkeh
    • 1
    • 2
    • 3
  • Henri Bismuth
    • 1
    • 2
    • 3
  1. 1.Hepato-Biliary SurgeryPaul Brousse HospitalFrance
  2. 2.Liver Transplant UnitPaul Brousse HospitalFrance
  3. 3.Faculty of MedicineUniversity of Paris SudVilejuifFrance

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