title: Surgical management of hepatic hemangiomas: a multi-institutional experience.
abstract: BACKGROUND
  The management of hepatic hemangiomas remains ill defined. This study sought to investigate the indications, surgical management and outcomes of patients who underwent a resection for hepatic hemangiomas.
  
  
  METHODS
  A retrospective review from six major liver centres in the United States identifying patients who underwent surgery for hepatic hemangiomas was performed. Clinico-pathological, treatment and peri-operative data were evaluated.
  
  
  RESULTS
  Of the 241patients who underwent a resection, the median age was 46 years [interquartile range (IQR): 39-53] and 85.5% were female. The median hemangioma size was 8.5 cm (IQR: 6-12.1). Surgery was performed for abdominal symptoms (85%), increasing hemangioma size (11.3%) and patient anxiety (3.7%). Life-threatening complications necessitating a hemangioma resection occurred in three patients (1.2%). Clavien Grade 3 or higher complications occurred in 14 patients (5.7%). The 30- and 90-day mortality was 0.8% (n = 2). Of patients with abdominal symptoms, 63.2% reported improvement of symptoms post-operatively.
  
  
  CONCLUSIONS
  A hemangioma resection can be safely performed at high-volume institutions. The primary indication for surgery remains for intractable symptoms. The development of severe complications associated with non-operative management remains a rare event, ultimately challenging the necessity of additional surgical indications for a hemangioma resection.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Miura
authors.forename: Albert
authors.initials: A
authors.lastname: Amini
authors.forename: Ryan
authors.initials: R
authors.lastname: Schmocker
authors.forename: Shawnn
authors.initials: S
authors.lastname: Nichols
authors.forename: Daniel
authors.initials: D
authors.lastname: Sukato
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Aijun
authors.initials: A
authors.lastname: Li
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000328:Adult; D005260:Female; D006391:Hemangioma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D061847:Hospitals, High-Volume; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014481:United States