What is the role of surgical resection in the treatment of hepatic hemangiomas?

Updated: Jun 17, 2019
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

The size and location of a lesion will influence the surgeon's decision to perform either a formal segmental resection of the hemangioma or an enucleation of the hemangioma. Typically, these procedures are performed using an open approach, but laparoscopic surgery can be performed in some cases. Hepatic lobectomy may be necessary in the case of large lesions.

In general, both surgical resection and enucleation are safe and are well tolerated by patients. Mortality rates of 0% have been reported in large series. Typically, postoperative morbidity is minimal, and the average length of hospital stay is 6 days. [58]

In a study of 172 patients with hepatic hemangiomas, Fu et al examined the safety of enucleation surgery for centrally located lesions versus that for peripheral lesions (76 and 96 patients, respectively). [59] In both groups, the frequency of major complications was low, although vascular inflow occlusion time, operating time, and hospital stay were longer in the central lesion group, and the volume of blood loss was greater. No hospital mortality occurred in either group. The authors concluded that enucleation is safe for both centrally and peripherally located hemangiomas, but that the surgery is technically more demanding for the former.

In the absence of tumor-promoting factors, such as estrogen therapy, hemangiomas rarely recur after successful resection. [60]


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