title: Surgical management of giant hepatic hemangiomas: complications and review of the literature.
abstract: BACKGROUND
  Hepatic hemangiomas are the most common benign hepatic tumors, and they are usually asymptomatic with normal liver function. When hepatic hemangiomas reach 4 cm, we define them as giant hemangiomas. Treatment options for giant hemangiomas are observation, surgical resection, and transcatheter arterial embolization. The aim of this study was to identify the risk factors for surgical complications.
  
  
  METHODS
  In this study, the records of 61 patients with giant hepatic hemangiomas treated with surgical resection at Chang Gung Memorial Hospital, Linkou were 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 were collected and analyzed.
  
  
  RESULTS
  There were 8 patients (13.1%, 95% confidence interval 5.8% to 24.2%) with complications after resection or enucleation. Postoperative complications were associated with large tumor size (p = 0.021) and tumors that were symptomatic (p = 0.017). In addition, complications were associated with greater 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 as endoscopic 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. Most complications were grade I and could be treated conservatively. Both resection and enucleation were relatively safe with an acceptable complication rate (13.1%) and no mortality in our study.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital at Linko, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Hui-Yu
authors.initials: HY
authors.lastname: Ho
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Wu
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yu
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006391:Hemangioma / Q000150:complications / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome