Management of hemangioma of the liver: surgical therapy or observation?
BACKGROUND
Elective surgery for liver hemangioma is controversial. We reviewed long-term outcomes following elective hepatectomy or observation only for symptomatic and asymptomatic liver hemangioma.


METHODS
All patients (n = 307) with liver hemangioma referred to our hospital for surgical evaluation from January 1988 to December 2009 were identified, and imaging results, tumor characteristics, surgical indication, surgical mode, outcome of observation, clinical and/or postoperative outcome, and adverse events were retrospectively evaluated.


RESULTS
Complete median follow-up for 246 patients was 124 months. Elective surgery was performed in 103 patients (symptomatic [n = 62] and asymptomatic [n = 41]). Postoperative morbidity occurred in 17 % of the patients and was significantly lower in asymptomatic patients (p = 0.002). No perioperative mortality was registered. Surgery relieved complaints in most (88 %) patients. In the observation group (n = 143), 56 % of patients had persistent or new onset of hemangioma-associated symptoms. Major hemangioma-related complications occurred in 12 patients (9 %) during the follow-up period, and 2 patients died after traumatic hemangioma rupture. Overall the rate of adverse events was by trend lower in the surgical group than in the observation group (35 versus 57 %; p = 0.08).


CONCLUSIONS
The majority of patients with liver hemangioma can be safely managed by clinical observation. In a subset of patients, especially those with giant hemangioma and/or occurrence of symptoms, surgical treatment could be considered and is justified in high-volume centers.
Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr.12, 91054, Erlangen, Germany. Sueleyman.Yedibela@uk-erlangen.de
Süleyman
S
Yedibela
Sedat
S
Alibek
Volker
V
Müller
Unal
U
Aydin
Melanie
M
Langheinrich
Clemens
C
Lohmüller
Werner
W
Hohenberger
Aristotelis
A
Perrakis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome