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Experience in surgical treatment of symptomatic hepatic hemangiomas

Yıl 2021, Cilt: 6 Sayı: 3, 100 - 103, 09.12.2021

Öz

Aim: Hemangioma is the most common benign tumor of the liver. They are rarely large, symptomatic, and show
atypical imaging patterns. Surgical treatment indications are persistent symptoms, rapid size increase, lifethreatening complications, and diagnostic uncertainty. In this study, we aimed to present the results of our
patients who underwent surgical treatment for persistent symptomatic hepatic hemangiomas regardless of size.
Methods: We retrospectively evaluated the clinicodemographics, perioperative findings, and postoperative
results of ten patients that we operated for symptomatic hepatic hemangiomas between 2017 and 2021. We
made the diagnosis based on ultrasonography, computed tomography, and magnetic resonance imaging. Patients
were evaluated in terms of age, gender, symptoms, tumor size and location, perioperative blood transfusion,
operation time, postoperative complications, length of stay, and follow-up results.
Results: The median age was 51 (25-60) and all of them were female. Although the persistent symptom in all
patients was abdominal pain, we also had patients with additional symptoms such as dyspepsia and nausea. We
performed enucleation in two, left lateral segmentectomy in one, right hepatectomy in two patients and, nonanatomical segmental resection in the rest. Perioperative blood transfusion was median 1 (0-3) unit and required
in seven. The median operation time was 170 (135-230) minutes, and the median postoperative stay was 8.5 (4-
13) days. No serious complications developed in the postoperative period. The median follow-up time was 23.5
(9-40) months and, there was no recurrence or notable long-term complications.
Conclusion: Surgical treatment can be performed safely and effectively in experienced centers for patients with
symptomatic hepatic hemangioma.

Kaynakça

  • 1. Belghiti J, Dokmak S, Vilgrain V, Paradis V. Benign liver lesions. Blumgart's Surgery of the Liver, Pancreas and Biliary Tract: Elsevier; 2012. p. 1250-67.
  • 2. Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg. 1970;172:239.
  • 3. Herman P, Costa ML, Machado MAC, Pugliese V, D'Albuquerque LAC, Machado MCC, et al. Management of hepatic hemangiomas: a 14-year experience. J Gastrointest Surg. 2005;9:853-9.
  • 4. Adhikari DR, Thakur V, Telavane PP, Kulkarni R, Singh R, Joshi RM. Hypergiant hepatic hemangiomas: case series. Indian J Surg. 2015;77:40-2.
  • 5. Özden İ, Poyanlı A, Önal Y, Demir AA, Hoş G, Acunaş B. Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas. World J Surg. 2017;41:2796-803.
  • 6. Hasan HY, Hinshaw JL, Borman EJ, Gegios A, Leverson G, Winslow ER. Assessing normal growth of hepatic hemangiomas during long-term follow-up. JAMA Surg. 2014;149:1266-71.
  • 7. Iwatsuki S, Starzl TE. Personal experience with 411 hepatic resections. Ann Surg. 1988;208:421.
  • 8. Iwatsuki S, Todo S, Starzl TE. Excisional therapy for benign hepatic lesions. Surg Gynecol Obstet. 1990;171:240.
  • 9. Özden İ, Emre A, Alper A, Tunacı M, Acarlı K, Bilge O, et al. Long-term results of surgery for liver hemangiomas. Arch Surg. 2000;135:978-81.
  • 10. Pietrabissa A, Giulianotti P, Campatelli A, Di Candio G, Farina F, Signori S, et al. Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg. 1996;83:915-8.
  • 11. Singh RK, Kapoor S, Sahni P, Chattopadhyay TK. Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl. 2007;89:490-3.
  • 12. Brouwers M, Peeters P, De Jong K, Haagsma E, Klompmaker I, Bijleveld C, et al. Surgical treatment of giant haemangioma of the liver. Br J Surg. 1997;84:314-6.
  • 13. Gedaly R, Pomposelli JJ, Pomfret EA, Lewis WD, Jenkins RL. Cavernous hemangioma of the liver: anatomic resection vs enucleation. Arch Surg. 1999;134:407-11.
  • 14. Hamaloglu E, Altun H, Ozdemir A, Ozenc A. Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg. 2005;29:890-3.
  • 15. Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg. 2004;139:818-23.
  • 16. Borgonovo G, Razzetta F, Arezzo A, Torre G, Mattioli F. Giant hemangiomas of the liver: surgical treatment by liver resection. Hepatogastroenterology. 1997;44:231-4.
  • 17. Belli L, De Carlis L, Beati C, Rondinara G, Sansalone V, Brambilla G. Surgical treatment of symptomatic giant hemangiomas of the liver. Surg Gynecol Obstet. 1992;174:474-8.
  • 18. Hu M, Chen K, Zhang X, Li C, Song D, Liu R. Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter. BMC Surg. 2020;20:1-10.
  • 19. Srivastava D, Gandhi D, Seith A, Pande G, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26:510-4.
  • 20. Giavroglou C, Economou H, Ioannidis I. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol. 2003;26:92-6.
  • 21. Tak WY, Park SY, Jeon SW, Cho CM, Kweon YO, Kim SK, et al. Ultrasonography-guided percutaneous radiofrequency ablation for treatment of a huge symptomatic hepatic cavernous hemangioma. J Clin Gastroenterol. 2006;40:167-70.

Semptomatik hepatik hemanjiomlarda cerrahi tedavi deneyimi

Yıl 2021, Cilt: 6 Sayı: 3, 100 - 103, 09.12.2021

Öz

Amaç: Hemanjiom, karaciğerin en sık görülen benign tümörüdür. Nadiren büyük, semptomatik ve atipik
görüntüleme paterninde olabilirler. Cerrahi tedavi endikasyonları, persistan semptomlar, hızlı boyut artışı,
yaşamı tehdit eden komplikasyonlar ve tanısal belirsizliktir. Bu çalışmada boyuttan bağımsız olarak persistan
semptomatik karaciğer hemanjiomları nedeniyle cerrahi tedavi uygulanan hastalarımızın sonuçlarını sunmayı
amaçladık.
Yöntemler: 2017-2021 yılları arasında semptomatik hepatik hemanjiyom nedeniyle opere ettiğimiz 10 hastanın
klinikodemografik verilerini, perioperatif bulgularını ve postoperatif sonuçlarını retrospektif olarak
değerlendirdik. Tanıyı ultrasonografi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme ile koyduk.
Hastalar yaş, cinsiyet, semptomlar, tümör boyutu ve yerleşimi, perioperatif kan transfüzyonu, operasyon süresi,
postoperatif komplikasyonlar, hastanede kalış süresi ve takip sonuçları açısından değerlendirildi.
Bulgular: Hastaların ortanca yaşı 51 yıl (25-60) idi ve hepsi kadındı. Hastaların tamamında persistan semptom
karın ağrısı olmakla birlikte, dispepsi ve bulantı gibi ek semptomu olan hastalarımız da mevcuttu. İki hastada
enükleasyon, birinde sol lateral segmentektomi, iki hastada sağ hepatektomi ve diğerlerinde anatomik olmayan
segmenter rezeksiyon yaptık. Perioperatif kan transfüzyonu medyan 1 (0-3) ünite idi ve yedi hastada transfüzyon
ihtiyacı oldu. Ortalama ameliyat süresi 170 (135-230) dakika ve ameliyat sonrası ortalama hastanede kalış süresi
8,5 (4-13) gündü. Postoperatif dönemde ciddi bir komplikasyon gelişmedi. Medyan takip süresi 23,5 (9-40) aydı
ve, nüks veya ciddi uzun dönem komplikasyon olmadı.
Sonuç: Semptomatik hepatik hemanjiyomlu hastalarda cerrahi tedavi, deneyimli merkezlerde güvenli ve etkin
bir şekilde uygulanabilir.

Kaynakça

  • 1. Belghiti J, Dokmak S, Vilgrain V, Paradis V. Benign liver lesions. Blumgart's Surgery of the Liver, Pancreas and Biliary Tract: Elsevier; 2012. p. 1250-67.
  • 2. Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg. 1970;172:239.
  • 3. Herman P, Costa ML, Machado MAC, Pugliese V, D'Albuquerque LAC, Machado MCC, et al. Management of hepatic hemangiomas: a 14-year experience. J Gastrointest Surg. 2005;9:853-9.
  • 4. Adhikari DR, Thakur V, Telavane PP, Kulkarni R, Singh R, Joshi RM. Hypergiant hepatic hemangiomas: case series. Indian J Surg. 2015;77:40-2.
  • 5. Özden İ, Poyanlı A, Önal Y, Demir AA, Hoş G, Acunaş B. Superselective transarterial chemoembolization as an alternative to surgery in symptomatic/enlarging liver hemangiomas. World J Surg. 2017;41:2796-803.
  • 6. Hasan HY, Hinshaw JL, Borman EJ, Gegios A, Leverson G, Winslow ER. Assessing normal growth of hepatic hemangiomas during long-term follow-up. JAMA Surg. 2014;149:1266-71.
  • 7. Iwatsuki S, Starzl TE. Personal experience with 411 hepatic resections. Ann Surg. 1988;208:421.
  • 8. Iwatsuki S, Todo S, Starzl TE. Excisional therapy for benign hepatic lesions. Surg Gynecol Obstet. 1990;171:240.
  • 9. Özden İ, Emre A, Alper A, Tunacı M, Acarlı K, Bilge O, et al. Long-term results of surgery for liver hemangiomas. Arch Surg. 2000;135:978-81.
  • 10. Pietrabissa A, Giulianotti P, Campatelli A, Di Candio G, Farina F, Signori S, et al. Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg. 1996;83:915-8.
  • 11. Singh RK, Kapoor S, Sahni P, Chattopadhyay TK. Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl. 2007;89:490-3.
  • 12. Brouwers M, Peeters P, De Jong K, Haagsma E, Klompmaker I, Bijleveld C, et al. Surgical treatment of giant haemangioma of the liver. Br J Surg. 1997;84:314-6.
  • 13. Gedaly R, Pomposelli JJ, Pomfret EA, Lewis WD, Jenkins RL. Cavernous hemangioma of the liver: anatomic resection vs enucleation. Arch Surg. 1999;134:407-11.
  • 14. Hamaloglu E, Altun H, Ozdemir A, Ozenc A. Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg. 2005;29:890-3.
  • 15. Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg. 2004;139:818-23.
  • 16. Borgonovo G, Razzetta F, Arezzo A, Torre G, Mattioli F. Giant hemangiomas of the liver: surgical treatment by liver resection. Hepatogastroenterology. 1997;44:231-4.
  • 17. Belli L, De Carlis L, Beati C, Rondinara G, Sansalone V, Brambilla G. Surgical treatment of symptomatic giant hemangiomas of the liver. Surg Gynecol Obstet. 1992;174:474-8.
  • 18. Hu M, Chen K, Zhang X, Li C, Song D, Liu R. Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter. BMC Surg. 2020;20:1-10.
  • 19. Srivastava D, Gandhi D, Seith A, Pande G, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26:510-4.
  • 20. Giavroglou C, Economou H, Ioannidis I. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol. 2003;26:92-6.
  • 21. Tak WY, Park SY, Jeon SW, Cho CM, Kweon YO, Kim SK, et al. Ultrasonography-guided percutaneous radiofrequency ablation for treatment of a huge symptomatic hepatic cavernous hemangioma. J Clin Gastroenterol. 2006;40:167-70.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Makale
Yazarlar

Oğuzhan Özşay 0000-0001-6291-2652

Mehmet Can Aydın 0000-0002-2379-1293

Yayımlanma Tarihi 9 Aralık 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 6 Sayı: 3

Kaynak Göster

Vancouver Özşay O, Aydın MC. Experience in surgical treatment of symptomatic hepatic hemangiomas. Arch Clin Exp Med. 2021;6(3):100-3.