Re-visiting the surgical management of giant hepatic hemangiomas: Enucleation versus Anatomical resection?

Abstract Background Resection is rarely indicated in giant hepatic hemangiomas (HH) that are symptomatic. Enucleation (EN), compared to anatomical resection (AR), is considered as the better technique to resect them as EN has been reported to have lower morbidity while conserving the normal liver tissue. But no study has yet clearly established the superiority of EN over AR. Also the independent predictors of postoperative morbidity have not been established. Methods All consecutive patients operated for HH at two specialized hepatobiliary centers were reviewed. Patient demographics, operative variables and post-operative outcomes were analyzed and compared between two techniques. Postoperative complications were graded according to Dindo Clavien classification of surgical complications. The aims of this study were to compare two techniques of HH resection with respect to postoperative outcomes and to identify the risk factors for 90-day major post-operative morbidity and mortality. Results A total of 64 patients including 41 AR, 22 EN and 1 liver transplantation were performed for HH during the study period. Ten patients (9 with size ≤4 cm and 1 transplant) were excluded. Fifty-four patients, majority being women (85%), with a median age of 48 years were operated for giant HH. These patients were classified into two groups based on the technique of resection namely EN (22 patients) and AR (32 patients). Both groups were comparable in all aspects except that number of liver segments resected was significantly more in AR. Post-operative outcomes were similar in both groups. Independent predictors of 90-day major complications including mortality were the use of total vascular exclusion [Relative Risk (RR): 2.3, p=0.028] and duration of surgery >4.5 hours [RR: 2.3, p=0.025]. Conclusion Both techniques yield similar results with respect to 90-day postoperative morbidity and mortality. The choice of technique should be based on the location of tumor and simplicity of liver resection.