Experience in surgical treatment of symptomatic hepatic hemangiomas

Abstract

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.

Keywords

• hepatic hemangioma
• liver resection
• enucleation

Semptomatik hepatik hemanjiomlarda cerrahi tedavi deneyimi

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.

Anahtar Kelimeler

• hepatik hemanjiom
• karaciğer rezeksiyonu
• enükleasyon

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