Liver hemangiomas – when is invasive treatment indicated?
Authors:
V. Třeška; T. Skalický; V. Liška; J. Fichtl; J. Brůha; M. Skála; J. Šebek; P. Duras
Authors‘ workplace:
Chirurgická klinika LF Univerzity Karlovy a FN v Plzni
přednosta: prof. MUDr. V. Třeška, DrSc.
Published in:
Rozhl. Chir., 2017, roč. 96, č. 4, s. 151-155.
Category:
Original articles
Overview
Introduction:
Liver hemangiomas are the most common benign tumors of the liver. Most are asymptomatic and are found accidentally by ultrasonography, computed tomography or magnetic resonance imaging of the abdomen. Liver hemangiomas usually do not need any treatment. Nevertheless, symptomatic, giant hemangiomas can be indicated for surgery, embolization or thermoablation. The aim of this study was to define based on our own experience and on the literature when and what treatment option should be indicated in patients suffering from liver hemangioma.
Method:
In the last five years 37 patients with giant hemangiomas indicated for invasive treatment were enrolled in the study. The mean size of the hemangiomas was 67 mm (45–221 mm). Multiple hemangiomas were present in 11 (29.7%) patients. Enucleation was performed in 15 (40.5%), non-anatomical liver resection in three, (8.1%), left lobectomy in one (2.7%) and exploratory laparotomy for a suspected malignant liver tumor in two (5.4%) patients where malignancy was excluded based on contrast enhanced peroperative ultrasonography. Percutaneous transarterial embolization (TAE) was performed in 16 (43.2%) patients.
Results:
There was zero mortality. A hematoma in the resection line, with spontaneous regression was present in two (10.5%) patients after the surgery. The post-embolization syndrome was presented in three (16.7%) patients after TAE. Progression of the hemangioma was seen in three (28.8%), regression in six (37.5%) patients, and in seven (43.8%) patients the finding remained stable in the interval of 1−4 years after TAE.
Conclusion:
Conservative approach is can be applied in most liver hemangiomas, especially in small, asymptomatic lesions. Liver surgery is indicated in giant symptomatic or growing hemangiomas with the diameter over 10 cm or in non-specific lesions where the preoperative diagnosis is uncertain. We recommend enucleation as the method of choice, or non-anatomic liver resection. TAE is indicated in high-risk patients and can be repeated if the hemangioma progresses. The use of other methods such as radiofrequency ablation needs to be verified in large clinical studies.
Key words:
liver hemangiomas – treatment methods
Sources
1. Bajenaru N, Balaban V, Savulescu F, et al. Hepatic hemangioma – review. Journal of Medicine and Life 2015;8:4−11.
2. Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg 1970;172:239−45.
3. Di Carlo I, Koshy R, Al Mudares S, et al. Giant cavernous liver hemangiomas: is it the time to change the size categories? Hepatobiliary Pancreat Dis Int 2016;15:21−9.
4. Fu XH, Lai EC, Yao XP, et al. Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? Am J Surge 2009;198:184−7.
5. Zhang W, Huang ZY, Ke ChS, et al. Surgical treatment of giant liver hemangioma larger than 10cm: A single center´s experience with 86 patients. Medicine 2015;94:1−8.
6. Glinkova V, Shevah O, Boaz M, et al. Hepatic haemangiomas: possible association with female sex hormones. Gut 2004;53:1352−5.
7. Moctezuma-Velázquez C, López-Arce G, Martínez-Rodríguez LA, et al. Giant hepatic hemangioma versus conventional hepatic hemangioma: clinical findings, risk factors, and management. Rev Gastroenterol Mex 2014;79:229−37.
8. La Vecchia C, Tavani A. Female hormones and benign liver tumours. Dig Liver Dis 2006;38:535−6.
9. Schnelldorfer T, Wave AL, Smoot R, et al. Management of giant hemangioma of the liver: resection versus observation J Am Coll Surg 2010;211:724−30.
10. Skalicky T, Treska V, Sutnar A, et al. Surgical treatment of benign liver tumours--indications and results. Zentralbl Chir 2009;134:141−4.
11. Třeška V, Ferda J, Skalický T, et al. Hemangiomy jater – diagnostika a léčba. Rozhl Chir 2007;86:28−31.
12. Hoekstra LT, Bieze M, Erdogan D, et al. Management of giant liver hemangiomas: an update. Expert Rev Gastroenterol Hepatol 2013;7:263−8.
13. Singh RK, Kapoor S, Sahni P, et al. Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl 2007;89:490−3.
14. Choi J, Lee YJ, Hwang DW, et al. Surgical treatment of giant hemangiomas: technical point of view. Am Surg 2011;77:48−54.
15. Vassiou K, Rountas H, Liakou P, et al. Embolization of a giant hepatic heamangioma prior to urgent liver resection. Case report and review of the literature. Cardiovasc Intervent Radiol 2007;30:800−2.
16. Firouznia K, Ghanaati H, Alavian SM, et al. Management of liver hemangioma using trans-catheter arterial embolization. Hepat Mon 2014; 14:e 25788.
17. Kayaalp C, Sabuncuoglu MZ. Embolization of liver hemangiomas. Hepat Mon 2015;15:e30334.
18. Malagari K, Alexopoulou E, Dourakis S, et al. Transarterial embolization of giant liver hemangiomas associated with Kasabach-Merritt syndrome: a case report. Acta Radiol 2007;48:608−12.
19. Li Y, Jia Y, Li S, et al. Transarterial chemoembolization of giant liver hemangioma: A multi-center study with 836 cases. Cell Biochem Biophys 2015;73:469−72.
20. Gao J, Ji JS, Ding XM, et al. Laparoscopic radiofrequency ablation for large subcapsular hepatic hemangiomas: Technical and clinical outcomes. PLOS one 2016. Available from: http://dx.doi.org/10.1371/journal.pone.0149755.
21. Ji J, Gao J. Zhao L, et al Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas. Medicine 2016;15:1−5.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2017 Issue 4
Most read in this issue
- Liver hemangiomas – when is invasive treatment indicated?
- Treatment of pelvic avulsion fractures in children and adolescents
- Solid pseudopapillary neoplasms of the pancreas
- Polymastia in unusual localization during pregnancy