Diagnosis, Management, and Outcome of 115 Patients with Hepatic Hemangiomas
Abstracts
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Introduction: Hemangiomas are the most common benign hepatic tumor, but the most appropriate management of these lesions remains poorly defined. Methods: All patients with the primary diagnosis of hepatic hemangioma evaluated at our institution between 1/92 and 12/00 were analyzed from our prospective database. Results: One hundred fifteen patients were identified with a median age of 52 (range 26-85) years old, and 65% were women. Nearly half of patients were asymptomatic. Abdominal pain or discomfort was the most common presenting symptom (38%), and 18% of patients had a palpable mass or hepatomegaly. A few patients presented with intratumoral bleeding (n=3) or Kasabach-Merritt syndrome (n=2). Liver function tests were normal in 81% of patients. Ultrasound (n=76) established the diagnosis in 34% of patients tested, CT scan (n=107) in 42%, and MR (n=73) in 77%. Only 3 of 13 percutaneous biopsies were diagnostic. In patients with large, central tumors considered for resection, angiography and more recently CT angiography were performed to identify the principal arterial supply. These studies confirmed the diagnosis in 25 of 29 patients (86%). Fifty-two patients underwent surgical resection, and 63 were observed. Indications for operation were: symptoms (60%), inability to exclude malignancy (29%), and large or increasing size (11%). Operations included: segmental, lobar, or extended lobar resection in 23 patients (44%), enucleation in 22 (42%), nonanatomic resection in 6 (12%), and laparoscopically-assisted resection in 1 (2%). Postoperative complications occurred in 13 patients (25%), and there were no deaths. Nearly all patients (96%) with resected hemangiomas had resolution of symptoms. Of the group that was observed (median follow-up 33 months), only 4 patients (6%) developed symptoms, 2 (3%) had tumor growth of more than 1 cm, and none had spontaneous hemorrhage. Conclusion: Hepatic hemangiomas can be diagnosed in most patients using non-invasive studies. Angiography and CT angiography are valuable preoperative studies, especially in patients with large, central tumors. When indicated, hemangiomas can be removed safely and often by enucleation rather than hepatectomy. Asymptomatic hemangiomas should be observed as very few will require resection. |
