What Is the Best Surgical Method of Addressing Hepatic Hemangiomas?

  • J. Michael MillisEmail author
  • David Caba Molina
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Hepatic hemangiomas are the most common benign tumor of the liver and the second most common tumor following metastases. The diagnosis and management of hepatic hemangiomas has improved significantly for the past decade. The decision to treat this tumors surgically should be based mostly on symptomatology, inability to exclude malignancy, documented growth and less on feasibility for resection or patient anxiety. The decision for observation should be based on a thorough examination of asymptomatic tumors with benign characteristics on imaging. The surgical treatment of choice has evolved from formal hepatectomies to selected enucleation with improvement in outcomes regardless of the size of the lesion. Minimal invasive techniques have similar results as open surgery in appropriately selected patients with no difference in morbidity and mortality.


Hepatic hemangioma Liver tumors Enucleation 


  1. 1.
    Iwatzuki S, Starzl TE. Personal experience with 411 hepatic resections. Ann Surg. 1988;208:421–34.CrossRefGoogle Scholar
  2. 2.
    Mortele KJ, Ros PR. Benign liver neoplasms. Clin Liver Dis. 2002;6:119–45.CrossRefPubMedGoogle Scholar
  3. 3.
    Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D. Benign and solid tumors of the liver: relationship to sex, age, size of tumors and outcomes. Ann Surg. 2001;67:173–8.Google Scholar
  4. 4.
    Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, Bertino G, Di Carlo I. What is changing in indications and treatment of hepatic hemangioma. A review. Ann Hepatol. 2014;13(4):327–39.PubMedGoogle Scholar
  5. 5.
    Yoon SS, Charny CK, Fong Y, Jarngin WR, Schwartz LH, Blumgart LH, DeMAtteo RP. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. Am Coll Surg. 2003;3:392–402.CrossRefGoogle Scholar
  6. 6.
    Schnelldorfer T, Ware AL, Smoot R, Schleck CD, Harmsen WS, Nagorney DM. Management of giant hemangioma of the liver: resection versus observation. Am Coll Surg. 2010;211(6):724–30.CrossRefGoogle Scholar
  7. 7.
    Alper A, Ariogul O, Emre A, et al. Treatment of liver hemangiomas by enucleation. Arch Surg. 1988;123:660–1.CrossRefPubMedGoogle Scholar
  8. 8.
    Fu xiao-Hui, Lai Eric Chun Hung, Yao Xiao-Ping, Chu Kai-Jian, Cheng Shu-Qun, Shen Feng, Meng Chao, Lau Wan Yee. Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions?. Am J Surg. 2009;198:184–87.Google Scholar
  9. 9.
    Suzuki H, Nimura Y, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M. Preoperative transcatheter arterial embolization for giant cavernous hemangioma of the liver with consumption coagulopathy. Am J Gastroenterol. 1997;92:688–91.PubMedGoogle Scholar
  10. 10.
    Soyer P, Levesque M. Hemoperitoneum due to spontaneous rupture of hepatic hemangiomatosis: treatment by super selective arterial embolization and partial hepatectomy. Autralas Radiol. 1995;39:90–2.CrossRefGoogle Scholar
  11. 11.
    Gaspar L, Mascarenhas F, da Costa MS, Dias JS, Alfonso JG, Silvestre ME. Radiation therapy in the unresectable cavernous hemangiomas of the liver. Radiother Oncol. 1993;29:45–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Giavroglou C, Economou H, Ioannidis. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Interv Radiol. 2003;26:92–6.CrossRefGoogle Scholar
  13. 13.
    Srivastava DN, Gandhi D, Seith A, Pande GK, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26:510–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Tsai HP, jeng LB, lee WC, Chen M. Clinical experience of hepatic hemangioma undergoing hepatic resection. Dig Dis Sci. 2003;48:916–20.Google Scholar
  15. 15.
    Borgonovo G, Razzeta F, Arezzo A, et al. Giant hemangiomas of the liver: surgical treatment by liver resection. Hepatogastroenterology. 1997;44:231–44.PubMedGoogle Scholar
  16. 16.
    Brouwers MA, Peeters PM, de Jong KP, et al. Surgical management of giant hemangioma of the liver. Br J Surg. 1997;84:314–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Moulton JS, et al. An algorithm for the accurate identification of benign liver lesions. Am J Surg. 2004;187:274–9.Google Scholar
  18. 18.
    Terkivaran T, de Wilt JH, de Man RA, van Rijin RR, Zondervan PE, Tilanus HW, et al. Indications and long term outcome of treatments for benign hepatic tumors: a critical appraisal. Arch Surg. 2001;136:1033–8.Google Scholar
  19. 19.
    Herman P, Costa MLV, Machado MA, Ougliese V, D’Albuquerque LA, Machado MC, Gama-Rodroguez JJ, Saad WA. Management of hepatic hemangiomas: a 14 year experience. J Gastrointest Surg. 2005;9:853–9.Google Scholar
  20. 20.
    Erdogan D, Busch OR, can Delden OM, Bennik RJ, ten Kate FJ, Gouma DJ, van Gulik TM. Management of liver hemangioma according to size and symptoms. J Gastroenterol Hepatol. 2007;11:1953–8.Google Scholar
  21. 21.
    Yedibela S, Alibek S, Muller V, Aydin U, Langheinrich M, Lohmuller C, Hohenberger W, Perrakis A. Management of hemangioma of the liver: surgical therapy or observation. World J Surg. 2013;37:1303–12.Google Scholar
  22. 22.
    Ozden I, Emre A, Alper A, et al. Long term results of surgery for liver hemangiomas. Arch Surg. 2000;135:978–81.Google Scholar
  23. 23.
    Kammula US, Buell JF, Labow DM, Rosen S, Millis JM, Posner MC. Surgical management of benign tumors of the liver. Int J Cancer. 2001;30(3):141–6.Google Scholar
  24. 24.
    Popescu I, Ciurea S, Brasoveaunu V, Hrehoret D, Boeti P, Georgecu S, Tulbure D. Liver hemangioma revisited: current surgical indications, technical aspects, results. Hepatogastroenterology. 2001;48(39):770–6.Google Scholar
  25. 25.
    Charny CK, Jarnagin WR, Schwartz LH, Fomeyer HS, De Matteo RP, Fong Y, et al. Management of 155 patients with benign liver tumors. Br J Surg. 2001;88:808–13.Google Scholar
  26. 26.
    Lerner SM, Hiatt Jr, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, Busuttil RW. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg. 2004;139:818–21.CrossRefPubMedGoogle Scholar
  27. 27.
    Hamaloglu E, Altun H, Ozdemir A, Ozenc A. Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg. 2005;29:890–3.Google Scholar
  28. 28.
    Singh RK, Kapoor S, Sahni P, Chattapadhyay T. Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl. 2007;89:490–3.Google Scholar
  29. 29.
    Giulainte F, Ardito F, Vellone M, Giordano M, Giuseppina R, Piccoli M, Giovannini I, Chiarla C, Nuzzo G. Am J Surg. 2011;201(6):741–8.Google Scholar
  30. 30.
    Giuliannotti PC, Adde P, Bianco FM. Robotic right hepatectomy for giant hemangioma in a Jehovah’s Witness. J Hepato-Biliary-Pancreat Sci. 2011;18:112–8.CrossRefGoogle Scholar
  31. 31.
    Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, et al. Laparoscopic liver resection of benign liver tumors. Surg Endosc. 2003;17:23–0.Google Scholar
  32. 32.
    Fan R-H, Chai F-L, He G-X, Wei L-X, Li R-Z, Wan W-X, Bai M-D, Zhu W-K, Cao M-L, Li H-M, Yan S-Z. Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma-A preliminary experience with 27 patient. Surg Endosc. 2006;20:281–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Belli G, D’Agostino A, Fantini C, Cioffi L, Belli A, Limongelli P, Russo G. Surgical treatment of giant liver hemangiomas by enucleation using an ultrasonically activated device (USAD). Hepatogastroenterology. 2009;56(89):236–9.Google Scholar
  34. 34.
    Ho, Hui-Yu, Wu Tsung-Han, Yu Ming Chin, Lee Wei-Chen, Chao Tzu-Cjieh, Chen Miin-Fu. Surgical management of giant hepatic hemangiomas: complications and review of literature. Chang Gung Med J. 2012;35(1):70–78.Google Scholar
  35. 35.
    Yang Y, Zhao LH, Fu SY, Lau WY, Lai EC, Gu FM, Wang ZG, Zhou WP. Selective vascular exclusion versus pringle maneuver in partial hepatectomy for liver hemangioma compressing or involving the major hepatic veins. Am Surg. 2014;80(30):236–40.PubMedGoogle Scholar
  36. 36.
    Miura JT, Amini A, Schmocker R, Nichols S, Sukato D, Winslow ER, Spolverato G. Ejaz A, Squires MH, Kooby DA, Maithel SK, Li A, Wu M-C, Sarmiento JM, Bloomston M, Christians KK, Johnston FM, Tsai S, Turaga KK, Tsung A, Pawlik TM, Gamblin TC. Surgical managements of hepatic hemangiomas: a multi-institutional experience. HPB (Oxford). 2014 Oct;16(10):924–8.Google Scholar
  37. 37.
    Liu CL, Fan ST, Lo CM, Chan SC, Tso WK, Ng IO, et al. Hepatic resection for incidentaloma. J Gastrointest Surg. 2004;8:785–93.CrossRefPubMedGoogle Scholar
  38. 38.
    Ibrahim S, Chen C-L, Shih-Ho W, Lin C-C, Yang C-H, Yong C-C, Jawan B, Cheng Y-F. Liver resection for benign liver tumors: indications and outcomes. Am J Surg. 2007;193:5–9.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Chicago HospitalsChicagoUSA

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