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Surgical Endoscopy

, Volume 30, Issue 2, pp 756–763 | Cite as

Comparison of laparoscopic radiofrequency ablation versus open resection in the treatment of symptomatic-enlarging hepatic hemangiomas: a prospective study

  • Xiaowu Zhang
  • Lunan Yan
  • Bo Li
  • Tianfu Wen
  • Wentao Wang
  • Mingqing Xu
  • Yonggang Wei
  • Jiayin YangEmail author
Article

Abstract

Background

Radiofrequency ablation (RFA) has been demonstrated to be a promising therapy for symptomatic large hepatic hemangioma. However, there is a lack of studies to demonstrate the benefits and disadvantages of RFA as compared with surgical resection for managing hepatic hemangioma. The aim of this study was to evaluate the outcomes of RFA compared with conventional open resection (ORES) for the treatment of symptomatic-enlarging hepatic hemangiomas.

Methods

A total of 66 patients with symptomatic-enlarging hepatic hemangiomas (4 cm ≤ diameter < 10 cm) who required surgical treatment were divided into two groups: 32 patients underwent laparoscopic radiofrequency ablation (LRFA) and the other 34 patients underwent ORES. We compared the two groups in terms of radiologic response, clinical response, operative time, estimated blood loss, postoperative pain score and analgesic requirement, length of hospital stay, postoperative complications and hospital cost.

Results

The radiologic and clinical responses were comparable between groups. LRFA had significantly shorter operative time (138 vs. 201 min, P < 0.001) and less blood loss (P < 0.001) than ORES. Patients after LRFA experienced significantly less pain and required less analgesia use. Moreover, patients underwent LRFA had significantly shorter length of hospital stay (P < 0.001) and lower hospital cost (P = 0.017). No severe morbidities or mortality was observed, and the overall morbidity rate was similar between groups.

Conclusions

As a new minimal invasive treatment option, laparoscopic radiofrequency ablation is as safe and effective a procedure as open resection for patients with symptomatic-enlarging hepatic hemangiomas smaller than 10 cm.

Keywords

Hepatic hemangioma Radiofrequency ablation Hepatectomy Laparoscopy 

Abbreviations

RFA

Radiofrequency ablation

LRFA

Laparoscopic radiofrequency ablation

PRFA

Percutaneous radiofrequency ablation

ORFA

Open radiofrequency ablation

ORES

Open resection

TAE

Transcatheter arterial embolization

LC

Laparoscopic cholecystectomy

CT

Computed tomography

MRI

Magnetic resonance imaging

PCIA

Patient-controlled intravenous analgesia

TB

Total bilirubin

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

POD

Postoperative day

Notes

Acknowledgments

This study was supported by a grant from the National Science and Technology Major Project of China (2012ZX10002-016 and 2012ZX10002-017).

Disclosures

Xiaowu Zhang, Lunan Yan, Bo Li, Tianfu Wen, Wentao Wang, Mingqing Xu, Yonggang Wei and Jiayin Yang have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Ochsner JL, Halpert B (1958) Cavernous hemangioma of the liver. Surgery 43:577–582PubMedGoogle Scholar
  2. 2.
    Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM et al (2004) Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 139:818–821 discussion 21–3 CrossRefPubMedGoogle Scholar
  3. 3.
    Adam YG, Huvos AG, Fortner JG (1970) Giant hemangiomas of the liver. Ann Surg 172:239–245PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Corigliano N, Mercantini P, Amodio PM, Balducci G, Caterino S, Ramacciato G et al (2003) Hemoperitoneum from a spontaneous rupture of a giant hemangioma of the liver: report of a case. Surg Today 33:459–463CrossRefPubMedGoogle Scholar
  5. 5.
    Tsai HP, Jeng LB, Lee WC, Chen MF (2003) Clinical experience of hepatic hemangioma undergoing hepatic resection. Dig Dis Sci 48:916–920CrossRefPubMedGoogle Scholar
  6. 6.
    Kawarada Y, Mizumoto R (1984) Surgical treatment of giant hemangioma of the liver. Am J Surg 148:287–291CrossRefPubMedGoogle Scholar
  7. 7.
    Farges O, Daradkeh S, Bismuth H (1995) Cavernous hemangiomas of the liver: are there any indications for resection? World J Surg 19:19–24CrossRefPubMedGoogle Scholar
  8. 8.
    Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A et al (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17:23–30CrossRefPubMedGoogle Scholar
  9. 9.
    Lanthaler M, Freund M, Nehoda H (2005) Laparoscopic resection of a giant liver hemangioma. J Laparoendosc Adv Surg Tech A 15:624–666CrossRefPubMedGoogle Scholar
  10. 10.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefPubMedGoogle Scholar
  11. 11.
    Srivastava DN, Gandhi D, Seith A, Pande GK, Sahni P (2001) Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging 26:510–514CrossRefPubMedGoogle Scholar
  12. 12.
    Mitsuhashi N, Furuta M, Sakurai H, Takahashi T, Kato S, Nozaki M et al (1997) Outcome of radiation therapy for patients with Kasabach–Merritt syndrome. Int J Radiat Oncol Biol Phys 39:467–473CrossRefPubMedGoogle Scholar
  13. 13.
    Iyer CP, Stanley P, Mahour GH (1996) Hepatic hemangiomas in infants and children: a review of 30 cases. Am Surg 62:356–360PubMedGoogle Scholar
  14. 14.
    N’Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E et al (2009) Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 50:1475–1483CrossRefPubMedGoogle Scholar
  15. 15.
    Tiong L, Maddern GJ (2011) Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 98:1210–1224CrossRefPubMedGoogle Scholar
  16. 16.
    Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89CrossRefPubMedGoogle Scholar
  17. 17.
    Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi K, Yamamoto Y et al (2008) Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepatogastroenterology 55(88):2171–2174PubMedGoogle Scholar
  18. 18.
    Cui Y, Zhou LY, Dong MK, Wang P, Ji M, Li XO et al (2003) Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma. World J Gastroenterol 9:2132–2134PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Fan RF, Chai FL, He GX, Wei LX, Li RZ, Wan WX et al (2006) Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients. Surg Endosc 20:281–285CrossRefPubMedGoogle Scholar
  20. 20.
    Park SY, Tak WY, Jung MK, Jeon SW, Cho CM, Kweon YO et al (2011) Symptomatic-enlarging hepatic hemangiomas are effectively treated by percutaneous ultrasonography-guided radiofrequency ablation. J Hepatol 54:559–565CrossRefPubMedGoogle Scholar
  21. 21.
    Zagoria RJ, Roth TJ, Levine EA, Kavanagh PV (2004) Radiofrequency ablation of a symptomatic hepatic cavernous hemangioma. Am J Roentgenol 182:210–212CrossRefGoogle Scholar
  22. 22.
    Hinshaw JL, Laeseke PJ, Weber SM, Lee FT Jr (2007) Multiple-electrode radiofrequency ablation of symptomatic hepatic cavernous hemangioma. Am J Roentgenol 189(3):W146–W149CrossRefGoogle Scholar
  23. 23.
    Zhang X, Yang J, Yan L (2013) Hepatobiliary and pancreatic: radiofrequency ablation for caudate lobe hemangioma. J Gastroenterol Hepatol 28:765CrossRefPubMedGoogle Scholar
  24. 24.
    Gao J, Ke S, Ding XM, Zhou YM, Qian XJ, Sun WB (2013) Radiofrequency ablation for large hepatic hemangiomas: initial experience and lessons. Surgery 153:78–85CrossRefPubMedGoogle Scholar
  25. 25.
    Ha JF, Sudhakar R, Chandraratna H (2008) Combination laparoscopic radiofrequency ablation and partial excision of hepatic hemangioma. Ochsner J 8:205–207PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Xiaowu Zhang
    • 1
    • 2
  • Lunan Yan
    • 1
  • Bo Li
    • 1
  • Tianfu Wen
    • 1
  • Wentao Wang
    • 1
  • Mingqing Xu
    • 1
  • Yonggang Wei
    • 1
  • Jiayin Yang
    • 1
    Email author
  1. 1.Department of Hepatic Surgery, Liver Transplantation Center, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of Regenerative Medicine Research Center, West China HospitalSichuan UniversityChengduChina

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