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Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experiences of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes.

Patients and Methods

This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017.

Results

Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5–31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical difference between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications.

Conclusion

Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobe HH, HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time

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References

  1. Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol 2005;39:401–412.

    Article  PubMed  Google Scholar 

  2. Duxbury MS, Garden OJ. Giant haemangioma of the liver: observation or resection? Dig Surg 2010;27:7–11.

    Article  PubMed  Google Scholar 

  3. Bajenaru N, Balaban V, Savulescu F, Campeanu I, Patrascu T: Hepatic hemangioma – review. J Med Life 2015; 8(spec issue):4–11.

    PubMed  PubMed Central  Google Scholar 

  4. Liu Y, Wei X, Wang K, Shan Q, Dai H, Xie H, Zhou L, Xu X, Zheng S. Enucleation versus Anatomic Resection for Giant Hepatic Hemangioma: A Meta-Analysis. Gastrointest Tumors. 2017;3(3–4):153–162.

    PubMed  PubMed Central  Google Scholar 

  5. Hamaloglu E, Altun H, Ozdemir A, Ozenc A. Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg. 2005;29(7):890–3.

    Article  PubMed  Google Scholar 

  6. Cheng WL, Qi YQ, Wang B, Tian L, Huang W, Chen Y. Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis. Ann R Coll Surg Engl. 2017;99(3):237–241.

    Article  PubMed  CAS  Google Scholar 

  7. Moctezuma-Velázquez C, López-Arce G, Martínez-Rodríguez LA, Escalona-Huerta C, Chapa-Ibargüengoitia M, Torre A. Giant hepatic hemangioma versus conventional hepatic hemangioma: clinical findings, risk factors, and management. Rev Gastroenterol Mex. 2014;79(4):229–37

    PubMed  Google Scholar 

  8. Hall GW: Kasabach-Merritt syndrome: pathogenesis and management. Br J Haematol 2001;112:851–862.

    Article  PubMed  CAS  Google Scholar 

  9. Terkivatan T, Vrijland WW, Den Hoed PT, De Man RA, Hussain SM, Tilanus HW. Size of lesion is not a criterion for resection during management of giant liver haemangioma. Br J Surg 2002; 89: 1240–4.

    Article  PubMed  CAS  Google Scholar 

  10. Terkivatan T, de Wilt JH, de Man RA, van Rijn RR, Zondervan PE, Tilanus HW. Indications and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg 2001; 136: 1033–8

    Article  PubMed  CAS  Google Scholar 

  11. Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, DeMatteo RP: Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003;197:392–402.

    Article  PubMed  Google Scholar 

  12. Xia F, Lau WY, Qian C, Wang S, Ma K, Bie P. Surgical treatment of giant liver hemangiomas: enucleation with continuous occlusion of hepatic artery proper and intermittent Pringle maneuver. World J Surg. 2010;34(9):2162–7

    Article  PubMed  Google Scholar 

  13. Di Carlo I, Koshy R, Al Mudares S, Ardiri A, Bertino G, Toro A: Giant cavernous liver hemangiomas: is it the time to change the size categories? Hepatobiliary Pancreat Dis Int 2016;15:21–29

    Article  PubMed  Google Scholar 

  14. Alper A, Ariogul O, Emre A, Uras A, Okten A: Treatment of liver hemangiomas by enucleation. Arch Surg 1988;123:660–661

    Article  PubMed  CAS  Google Scholar 

  15. Wu CX, Bao WY, Zhu F. Enucleation is Better for a Giant Hemangioma Proximal to the Hepatic Portal Vascular Structures. Indian J Surg. 2016;78(4):304–8.

    Article  PubMed  Google Scholar 

  16. Singh RK, Kapoor S, Sahni P, Chattopadhyay TK. Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl. 2007;89(5):490–3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205–213.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fukushima K, Fukumoto T, Kuramitsu K, Kido M, Takebe A, Tanaka M, Itoh T, Ku Y. Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma. J Gastrointest Surg. 2014;18(4):729–36.

    Article  PubMed  Google Scholar 

  19. Yamashita Y, Ogata I, Urata J, Takahashi M. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radiology 1997;203:121–125

    Article  PubMed  CAS  Google Scholar 

  20. Danet IM, Semelka RC, Braga L, Armao D, Woosley JT. Giant hemangioma of the liver: MR imaging characteristics in 24patients. Magn. Reson.Imaging 2003;21:95–101

    Article  PubMed  Google Scholar 

  21. Qiu J, Chen S, Wu H. Quality of life can be improved by surgical management of giant hepatic haemangioma with enucleation as the preferred option. HPB (Oxford). 2015;17(6):490–4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dong J, Zhang M, Chen JQ, Ma F, Wang HH, Lv Y. Tumor size is not a criterion for resection during the management of giant hemangioma of the liver. Eur J Gastroenterol Hepatol. 2015;27(6):686–91.

    Article  PubMed  Google Scholar 

  23. Fu XH, Lai EC, Yao XP, Chu KJ, Cheng SQ, Shen F, Wu MC, Lau WY. Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? Am J Surg. 2009;198(2):184–7

    Article  PubMed  Google Scholar 

  24. Ulas M, Ozer I, Bostancil EB, Karaman K, Dalgic T, Polatl E, Ercan M, Ozogul YB, Akoglul M. Giant hemangiomas: effects of size and type of surgical procedure on postoperative outcome Hepatogastroenterology. 2014;61(133):1297–301.

    PubMed  Google Scholar 

  25. Liu X, Yang Z, Tan H, Liu L, Xu L, Sun Y, Si S, Huang J, Zhou W. Characteristics and operative treatment of extremely giant liver hemangioma >20 cm. Surgery. 2017;161(6):1514–1524.

    Article  PubMed  Google Scholar 

  26. M Abdel Wahab, N Elghwalby, O Fathy, N Bisuony, Kh Abdel Wahab, M El Sorogy. Enucleation of a five-kilograms hemangioma of the caudate lobe of the liver: A case report. IJCRI 2013;4 (7):358–362

    Article  Google Scholar 

  27. Giuliante F, Ardito F, Vellone M, Giordano M, Ranucci G, Piccoli M, Giovannini I, Chiarla C, Nuzzo G: Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients. Am J Surg 2011;201:741–748

    Article  PubMed  Google Scholar 

  28. Zimmermann A, Baer HU. Fibrous tumor-liver interface in large hepatic neoplasms: its significance for tumor resection and enucleation. Liver Transpl Surg 1996; 2: 192–9

    Article  PubMed  CAS  Google Scholar 

  29. Zhang W, Huang ZY, Ke CS, Wu C, Zhang ZW, Zhang BX, Chen YF, Zhang WG, Zhu P, Chen XP: Surgical treatment of giant liver hemangioma larger than 10 cm: a single center’s experience with 86 patients. Medicine (Baltimore) 2015;94:e1420

    Article  Google Scholar 

  30. John T Miura, Albert Amini, Ryan Schmocker, Shawnn Nichols, Daniel Sukato, Emily R Winslow, Gaya Spolverato, Aslam Ejaz, Malcolm H Squires, David A Kooby, Shishir K Maithel, Aijun Li, Meng-Chao Wu, Juan M Sarmiento, Mark Bloomston, Kathleen K Christians, Fabian M Johnston, Susan Tsai, Kiran K Turaga, Allan Tsung, Timothy M Pawlik, T Clark Gamblin. Surgical management of hepatic hemangiomas: a multi-institutional experience. HPB (Oxford) 2014; 16(10): 924–928.

    Article  Google Scholar 

  31. Popescu I, Ciurea S, Brasoveanu V, Hrehoret D, Boeti P, Georgescu S, Tulbure D. Liver hemangioma revisited: current surgical indications, technical aspects, results. Hepatogastroenterology. 2001;48:770–776.

    PubMed  CAS  Google Scholar 

  32. Brouwers MA, Peeters PM, de Jong KP, Haagsma EB, Klompmaker IJ, Bijleveld CM, Zwaveling JH, Slooff MJ. Surgical treatment of giant haemangioma of the liver. Br J Surg. 1997;84:314–316

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Gastroenterology Surgical Center, Hepatobiliary and Pancreatic Surgery, Mansoura University, Mansoura, 35516, Egypt

    Mohamed Abdel Wahab, Ayman El Nakeeb, Mahmoud Abdelwahab Ali, Youssef Mahdy, Ahmed Shehta, Mohamed Abdulrazek & Mohamed El Desoky

  2. Radiology Department, Mansoura University, Mansoura, 35516, Egypt

    Rihame Abdel Wahab

Authors
  1. Mohamed Abdel Wahab
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  2. Ayman El Nakeeb
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  3. Mahmoud Abdelwahab Ali
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  4. Youssef Mahdy
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  5. Ahmed Shehta
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  6. Mohamed Abdulrazek
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  7. Mohamed El Desoky
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  8. Rihame Abdel Wahab
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Contributions

• Study conception and design: Mohamed Abdel Wahab

• Acquisition of data: Mohamed Abdel Wahab, Ayman El Nakeeb, Mahmoud Abdelwahab Ali, Youssef Mahdy, Ahmed Shehta, Mohamed Abdulrazek, Mohamed El Desoky, Rihame Abdel Wahab

• Analysis and interpretation of data: Ayman El Nakeeb, Mahmoud Abdelwahab Ali, Youssef Mahdy

• Critical revision of manuscript: Mohamed Abdel Wahab, Ayman El Nakeeb

Corresponding authors

Correspondence to Mohamed Abdel Wahab, Ayman El Nakeeb or Rihame Abdel Wahab.

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Manuscript has been seen and approved by all authors. It has not been submitted for publication in any other journal and will not subsequently be submitted for potential publication in another journal until a decision has been made, nor has it been published previously in any media.

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Abdel Wahab, M., El Nakeeb, A., Ali, M.A. et al. Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients. J Gastrointest Surg 22, 849–858 (2018). https://doi.org/10.1007/s11605-018-3696-y

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  • DOI: https://doi.org/10.1007/s11605-018-3696-y

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