Surgical treatment of hepatic hemangiomas: a study of 908 patients

Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery. Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017. The clinical data, surgical indications, surgical outcomes, lesion size, and the effect of TAE were compared. Results The diameter (mean + /- S. D.) of the resected hepatic cavernous hemangiomas was (11.1±6.2) cm (the longest diameter was 60 cm). 585 patients (64.4%) underwent enucleation of hepatic hemangiomas and 323 patients (35.6%) underwent anatomical hepatectomy. Six patients died perioperatively (mortality rate 0.7%). The incidence of severe complication (Clavien-Dindo grade 3~5) was 3.8%. The incidence of severe postoperative complication for enucleation (2.7%) was significantly less than anatomic liver resection (5.6%, P<0.05). When the lesion was more than 20 cm, the complication and mortality rates were significantly higher than those less than 20 cm (P<0.05). The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P<0.05). Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy. With increase in tumor size, the risk of surgery increased. Surgical treatment was safe and effective for giant hepatic hemangiomas. For giant hepatic hemangiomas with significant increase in size, prompt surgical treatment is recommended. Key words: Hemangiomas, hepatic; Enucleation; Anatomical hepatectomy; Complications; Transcatheter arterial embolization (TACE)