Yoshihiro Sakamoto1, Norihiro Kokudo2, Takeyuki Watadani3, Junji Shibahara4, Masakazu Yamamoto5, Hiroki Yamaue6. 1. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan. 2. National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. 3. Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan. 4. Department of Pathology, Kyorin University Hospital, Tokyo, Japan. 5. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 6. 2nd Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Abstract
BACKGROUND: Surgical indications for liver hemangioma remain unclear. METHODS: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5-10 cm (n = 164, 32%), Group C 10-15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). RESULTS: Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. CONCLUSIONS: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5-10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.
BACKGROUND: Surgical indications for liver hemangioma remain unclear. METHODS: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5-10 cm (n = 164, 32%), Group C 10-15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). RESULTS:Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. CONCLUSIONS: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5-10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.
Authors: Wei Long Cai; Xiao Ming Ma; Xu Heng Sun; Tai Ren; Cong Yun Huang; Yong Sheng Li; Xu An Wang; Ying Bin Liu; Shu You Peng Journal: World J Surg Oncol Date: 2020-06-10 Impact factor: 2.754