Abstract
Background
Elective surgery for liver hemangioma is controversial. We reviewed long-term outcomes following elective hepatectomy or observation only for symptomatic and asymptomatic liver hemangioma.
Methods
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.
Results
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).
Conclusions
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.
Similar content being viewed by others
References
Ishak KG, Rabin L (1975) Benign tumors of the liver. Med Clin North Am 59:995–1013
Trotter JF, Everson GT (2001) Benign focal lesions of the liver. Clin Liver Dis 5:17–42
Gandolfi L, Leo P, Solmi L et al (1991) Natural history of hepatic hemangioma: clinical and ultrasound study. Gut 32:677–680
Trastek VF, van Heerden JA, Sheedy PF et al (1983) Cavernous hemangiomas of the liver: resect or observe? Am J Surg 145:49–53
Adams YG, Huvos AG, Fortner JG (1970) Giant hemangiomas of the liver. Ann Surg 172:239–245
Berliner L, Ferzli G, Gianvito L et al (1983) Giant cavernous hemangioma of the liver complicated by abscess and thrombosis. Am J Gastroenterol 78:835–840
Kawarada Y, Mizumoto R (1984) Surgical treatment of giant hemangioma of the liver. Am J Surg 148:287–291
Yoon SS, Charny CK, Fong Y et al (2003) Diagnosis, management, and outcome of 115 patients with hepatic hemangiomas. J Am Coll Surg 197:392–402
Schnelldorfer T, Ware AL, Smoot R et al (2010) Management of giant hemangioma of the liver: resection versus observation. J Am Coll Surg 211:724–730
Ott R, Hohenberger W (1998) Focal nodular hyperplasia and liver cell adenoma: resection or observation? Zentralbl Chir 123:145–153
Özden I, Emre A, Alper A et al (2000) Long-term results of surgery for liver hemangiomas. Arch Surg 135:978–981
Pietrabissa A, Giulianotti P, Campatelli A et al (1996) Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg 83:915–918
Yamagata M, Kanematsu T, Matsumata T et al (1991) Management of haemangioma of the liver: comparison of results between surgery and observation. Br J Surg 78:1223–1225
Starzl TE, Koep LJ, Weil R 3rd et al (1980) Excisional treatment of cavernous hemangioma of the liver. Ann Surg 192:25–27
Brouwers MAM, Peeters PMJG, De Jong KP et al (1997) Surgical treatment of giant hemangioma of the liver. Br J Surg 84:314–316
Moreno-Egea A, Del Pozo RM, Vicente CM et al (1996) Indications for surgery in the treatment of hepatic hemangioma. Hepatogastroenterology 43:422–426
Erdogan D, Busch OR, van Delden OM et al (2007) Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol 22:1953–1958
Charny CK, Jarnagin WR, Schwartz LH et al (2001) Management of 155 patients with benign liver tumours. Br J Surg 88:808–813
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Goldsmith NA, Woodburne RT (1957) The surgical anatomy pertaining to liver resection. Surg Gynecol Obstet 105:310–318
Schwartz SI, Husser WC (1987) Cavernous hemangioma of the liver. Ann Surg 205:456–465
Gedaly R, Pomposelli JJ, Pomfret EA et al (1999) Cavernous hemangioma of the liver: anatomic resection vs enucleation. Arch Surg 134:407–411
Terkivatan T, Vrijland WW, den Hoed PT et al (2002) Size of lesion is not a criterion for resection during management of giant liver haemangioma. Br J Surg 89:1240–1244
Terkivatan T, De Wilt JHW, De Man RA et al (2001) Indication and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg 136:1033–1038
Weinmann A, Ringe B, Klempnauer J et al (1997) Benign liver tumors: differential diagnosis and indication for surgery. World J Surg 21:983–991. doi:10.1007/s002689900337
Herman P, Costa MLV, Machado MAC et al (2005) Management of hepatic hemangiomas: a 14-year experience. J Gastrointest Surg 9:853–859
Giuliante F, Ardito F, Vellone M et al (2011) Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients. Am J Surg 201:741–748
Hamaloglu E, Altun H, Ozdemir A et al (2005) Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg 29:890–893. doi:10.1007/s00268-005-7661-z
Pichlmayr R, Grosse H, Hauss J et al (1990) Technique and preliminary results of extracorporeal liver surgery and surgery on the in situ perfused liver? Br J Surg 77:21–26
Descottes B, Lachachi F, Durand-Fontanier S et al (2000) Laparoscopic treatment of solid and cystic tumors of the liver. Study of 33 cases. Ann Chir 125:941–947
Couinaud C (1954) Anatomic principles of left and right regulated hepatectomy: technics. J Chir (Paris) 70:933–966
Scheele J (2001) Anatomical and atypical liver resections. Chirurg 72:113–124
Yedibela S, Demir R, Zhang W et al (2009) Surgical treatment of mass-forming intrahepatic cholangiocarcinoma: an 11-year Western single-center experience in 107 patients. Ann Surg Oncol 16:404–412
Glinkova V, Shevah O, Boaz M et al (2004) Hepatic hemangiomas: possible association with female sex hormones. Gut 53:1352–1355
Cobey FC, Salem RR (2004) A review of liver masses in pregnancy and proposed algorithm for their diagnosis and management. Am J Surg 187:181–191
Mirk P, Rubaltelli L, Bazzocchi M et al (1982) Ultrasonographic patterns in hepatic hemangiomas. J Clin Ultrasound 10:373–378
Gibney RG, Hendin AP, Cooperberg PL (1987) Sonographically detected hepatic hemangiomas: absence of change over time. AJR 149:953–957
Caseiro-Alves F, Brito J, Araujo AE et al (2007) Normal vascular and biliary hepatic anatomy: 3D demonstration by multidetector CT. Surg Radiol Anat 29:575–582
Semelka RC, Martin DR, Balci C et al (2001) Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement. J Magn Reson Imaging 13:397–401
Namimoto T, Yamashita Y, Sumi S et al (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204:739–744
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Additional information
Süleyman Yedibela and Sedat Alibek contributed equally to this work.
Rights and permissions
About this article
Cite this article
Yedibela, S., Alibek, S., Müller, V. et al. Management of Hemangioma of the Liver: Surgical Therapy or Observation?. World J Surg 37, 1303–1312 (2013). https://doi.org/10.1007/s00268-013-1904-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-1904-1