Surgical Management of Giant Hepatic Hemangiomas: Complications and Review of the Literature

Background: Hepatic hemangiomas are the most common benign hepatic tumors, and theyare usually asymptomatic with normal liver function. When hepatic hemangiomas reach 4 cm, we define them as giant hemangiomas. Treatmentoptions for giant hemangiomas are observation, surgical resection, and transcatheter arterial embolization. The aim of this study was to identify the riskfactors for surgical complications.Methods: In this study, the records of 61 patients with giant hepatic hemangiomastreated with surgical resection at Chang Gung Memorial Hospital, Linkouwere retrospectively reviewed. Data on clinical variables including symptoms, the size, number, and location of the tumors, preoperative liver function tests, operative method, operation time, and operative blood loss werecollected and analyzed.Results: There were 8 patients (13.1%, 95% confidence interval 5.8% to 24.2%) withcomplications after resection or enucleation. Postoperative complicationswere associated with large tumor size (p = 0.021) and tumors that weresymptomatic (p = 0.017). In addition, complications were associated withgreater use of intraoperative inflow control (p = 0.053), longer operative time(p = 0.001), and greater intraoperative blood loss (p = 0.022). Most complications could be treated conservatively, but invasive interventions such asendoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage were required for management of grade III complications.Conclusions:Most giant hepatic hemangiomas can be treated with enucleation or resection. Important factors associated with complications were large tumor size,the presence of symptoms, surgical bleeding, and prolonged surgery. Mostcomplications were grade I and could be treated conservatively. Both resection and enucleation were relatively safe with an acceptable complicationrate (13.1%) and no mortality in our study.