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1
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Zdanowicz-Ratajczak A, Patrzałek D, Janczak D, Guziński M. Evaluation of Predictive Factors for Transarterial Bleomycin-Lipiodol Embolization Success in Treating Giant Hepatic Hemangiomas. Cancers (Basel) 2024; 17:42. [PMID: 39796672 PMCID: PMC11718885 DOI: 10.3390/cancers17010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 12/21/2024] [Accepted: 12/26/2024] [Indexed: 01/13/2025] Open
Abstract
Introduction: Giant hepatic hemangiomas are challenging to manage, requiring effective therapeutic approaches. Transarterial bleomycin-lipiodol embolization (TACE) has shown promise as a treatment option, yet predictive factors for its success are not well defined. This study aimed to assess the efficacy of TACE for giant hepatic hemangiomas and identify factors influencing treatment outcomes. Methods: A retrospective analysis of 31 adult patients who underwent TACE with bleomycin and lipiodol between December 2014 and October 2022 was conducted. Clinical parameters including age, sex, hemangioma location, lesion size, bleomycin dose, number of TACE sessions, and follow-up duration were evaluated. The primary outcome was hemangioma volume reduction, with statistical analyses identifying factors associated with significant lesion regression. Results: Higher bleomycin doses and longer intervals from procedure to follow-up were positively correlated with hemangioma volume reduction, while variables such as patient sex and lesion location showed no statistically significant impact on clinical success. The findings suggest that increased bleomycin dosage and extended follow-up periods may enhance treatment efficacy. Conclusions: The study identifies bleomycin dose and follow-up duration as predictive factors for TACE success in treating giant hepatic hemangiomas, underscoring their role in optimizing therapeutic strategies. These insights contribute to improved treatment personalization for patients with giant hepatic hemangiomas and highlight the need for further prospective studies to validate and expand upon these findings.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Mateusz Dorochowicz
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Agata Zdanowicz-Ratajczak
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Akhlaghpour S. Commentary on Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03922-7. [PMID: 39638970 DOI: 10.1007/s00270-024-03922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 11/16/2024] [Indexed: 12/07/2024]
Affiliation(s)
- Shahram Akhlaghpour
- Pardis Noor Medical Imaging and Cancer Center, No.5, 25th St, Saadat Abad Ave, Tehran, Iran.
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3
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Küsbeci M, Elek A, Oztürk E, Bozkaya H, Cınar C, Parıldar M, Oran I. Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion. Cardiovasc Intervent Radiol 2024; 47:1506-1514. [PMID: 39406873 DOI: 10.1007/s00270-024-03876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 09/27/2024] [Indexed: 11/08/2024]
Abstract
PURPOSE To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. MATERIALS AND METHODS Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36 months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3 years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. RESULTS A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73 mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6 cm3 (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15 years. CONCLUSION TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up.
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Affiliation(s)
- Mahmut Küsbeci
- Faculty of Medicine, Department of Interventional Radiology, Ege University, Izmir, Turkey
| | - Alperen Elek
- Faculty of Medicine, Department of Interventional Radiology, Ege University, Izmir, Turkey.
| | - Egemen Oztürk
- Department of Radiology, Usak Training and Research Hospital, Usak, Turkey
| | - Halil Bozkaya
- Department of Interventional Radiology, Medicana International Hospital, Izmir, Turkey
| | - Celal Cınar
- Faculty of Medicine, Department of Interventional Radiology, Ege University, Izmir, Turkey
| | - Mustafa Parıldar
- Faculty of Medicine, Department of Interventional Radiology, Ege University, Izmir, Turkey
| | - Ismail Oran
- Faculty of Medicine, Department of Interventional Radiology, Ege University, Izmir, Turkey
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Yang C, Chen L, Teng Y, Zhang R, Zhu L. Clinical impact and role of major vessels involvement in laparoscopic resection for hepatic hemangioma. Surg Endosc 2024; 38:3957-3966. [PMID: 38844729 DOI: 10.1007/s00464-024-10950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Severe bleeding remains a significant concern in laparoscopic resection for hepatic hemangioma. It is rarely reported that how the degree of major vessels involvement impacts on severe bleeding. The present study primarily aimed to analyze the impacts of the number of involved major vessels (NIMV) during laparoscopic surgery for hepatic hemangioma and evaluate the risk factors associated with increased bleeding. METHODS A database search was carried out for consecutive patients who underwent laparoscopic resection for liver hemangiomas at our department from January 2018 to December 2023. The collected data included demographics, characteristics of the hemangiomas, laboratory data, operation method, surgical and postoperative variables. RESULTS A total of 72 patients were enrolled in the study. 42 patients were categorized into the group with NIMV < 2, while 30 patients were divided into the group with NIMV ≥ 2. The group with NIMV ≥ 2 demonstrated a significant correlation with special segments, involved multiple segments and diameter of the hemangiomas (P < 0.01). And the perioperative variables including the extent of resection, operative time, blood loss, Pringle maneuver times, postoperative stay, drainage tube duration, and postoperative liver function (ALT, AST) also showed significant differences between the two groups (P < 0.05). Notably, NIMV ≥ 2 was identified as the most important independent risk factor for intraoperative blood loss ≥ 500 ml in laparoscopic surgery for hepatic hemangioma (P = 0.011). For NIMV ≥ 2, the independent risk factor was special segments in multivariate analysis (P = 0.000). CONCLUSION The involvement of multiple major vessels (NIMV ≥ 2) was significantly associated with special segments, resulting in increased intraoperative blood loss, operation difficulty, and delayed postoperative recovery. Moreover, it was identified as the single independent risk factor with a considerable risk for increased blood loss during laparoscopic resection for hepatic hemangioma.
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Affiliation(s)
- Chongwei Yang
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Li Chen
- Departments of Laboratory Medicine, the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, 430014, China
| | - Yali Teng
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Rixin Zhang
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Ling Zhu
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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Kacała A, Dorochowicz M, Matus I, Puła M, Korbecki A, Sobański M, Jacków-Nowicka J, Patrzałek D, Janczak D, Guziński M. Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:449. [PMID: 38541175 PMCID: PMC10972168 DOI: 10.3390/medicina60030449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 10/30/2024]
Abstract
Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used for diagnosis. Cavernous hemangioma is the most frequent type, but radiologists must be aware of other varieties. Conservative management is often adequate, but some cases necessitate targeted interventions. Although surgery was traditionally the main treatment, the evolution of minimally invasive procedures now often recommends transarterial chemoembolization as the treatment of choice.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Iwona Matus
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Jagoda Jacków-Nowicka
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Puła M, Patrzałek D, Janczak D, Guziński M. Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness. Cancers (Basel) 2024; 16:380. [PMID: 38254869 PMCID: PMC10814004 DOI: 10.3390/cancers16020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | | | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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7
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Furumaya A, van Rosmalen BV, de Graeff JJ, van der Poel MJ, Ramsoekh DS, Kazemier G, Verheij J, Takkenberg RB, Besselink MG, Erdmann JI, van Gulik TM. Relief of symptoms and quality of life after conservative versus surgical treatment of benign liver tumors (CONSULT): a retrospective propensity score matched study. HPB (Oxford) 2023:S1365-182X(23)00073-4. [PMID: 36990916 DOI: 10.1016/j.hpb.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Surgery can be considered for selected patients with benign liver tumours (BLT). The aim of this study was to compare symptoms and quality of life (QoL) after conservative and surgical management of BLT. METHODS In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were compared between surgically and conservatively treated patients by matched t-tests. Propensity score matching attempted to reduce confounding. Higher scores indicate less symptoms and higher QoL. RESULTS Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included at median 95 (IQR:66-120) and 91 (IQR:52-129) months, respectively. Most surgically treated patients reported stable, improved or disappeared symptoms (87%) and would undergo surgery again (94%). After propensity score matching, surgical patients had higher SumScores (mean difference 9.2, 95%CI:1.0-17.4, p = 0.028) but not higher QoL scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients in both groups). DISCUSSION Patients who had undergone surgery often reported they would undergo surgery again. Moreover, they had less symptoms than conservatively managed patients while they were propensity score matched on relevant variables, including baseline symptoms.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Jan Jaap de Graeff
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marcel J van der Poel
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - D Sandjai Ramsoekh
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Pathology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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8
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Heise D, Neumann UP. [Benign solid liver tumors]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01809-w. [PMID: 36811685 DOI: 10.1007/s00104-023-01809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/24/2023]
Abstract
Benign solid liver tumors are frequently discovered during routine sonographic examinations. As a rule, malignant tumors can be excluded using contrast medium-based sectional imaging; however, unclear cases can represent a diagnostic challenge. The category of solid benign liver tumors includes first and foremost hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH) and hemangioma. Based on the most recent data, an overview of the current standards in the diagnostics and treatment is given.
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Affiliation(s)
- Daniel Heise
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Ulf Peter Neumann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Niederlande
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9
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Furumaya A, Nooijen LE, Haring MPD, van Oers HA, van Beneden M, van Rosmalen BV, Takkenberg RB, Kazemier G, Besselink MG, de Meijer VE, Erdmann JI. Development of a set of patient reported outcome measures for patients with benign liver tumours and cysts: patient focus groups and systematic review. J Patient Rep Outcomes 2022; 6:124. [PMID: 36484883 PMCID: PMC9733760 DOI: 10.1186/s41687-022-00531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) may be useful for patients with benign liver tumours and cysts (BLTC) to evaluate the impact of treatment and/or guide shared decision making. Yet, a set of PROMs relevant to patients with BLTC is currently unavailable. In this study, we selected a PROMs set for patients with BLTC. METHODS Potentially relevant patient reported outcomes (PROs) were selected by psychologist-researchers based on keywords used or suggested by participants of two virtual focus groups meetings consisting of thirteen female BLTC patients with a median age of 50 years. Subsequently, patients were asked to report their most relevant PROs. PROMs identified by systematic literature review and computerized adaptive tests (CATs) in the Patient-Reported Outcomes Measurement Information System (PROMIS) were considered in selecting the final PROMs set to assess relevant outcomes. RESULTS The most important PROs were: insecurity/anxiety (11/12 patients), pain (9/12 patients), fatigue (8/12 patients), and limitations in daily life (5/12 patients). The literature review included 23 studies, which used various generic and disease-specific PROMs, often not measuring (all) relevant PROs. The final selected PROMs set included numerical rating scales for pain, two questions on overall health and quality of life and four PROMIS CATs. CONCLUSIONS A PROMs set generically and efficiently measuring outcomes relevant for patients with BLTC was developed and may be used in future research and clinical practice.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Lynn E Nooijen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Martijn P D Haring
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedy A van Oers
- Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development and Amsterdam Public Health, Amsterdam, The Netherlands
| | - Marlou van Beneden
- Department of Strategy and Policy and Care Support, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Vincent E de Meijer
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
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10
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Li L, Xu L, Wang P, Liu F, Wei Y, Xu M, Zhang M, Li B. Advantages of laparoscopic hepatic hemangioma surgery in quality of life: a prospective study. Surg Endosc 2022; 36:8967-8974. [PMID: 35701674 DOI: 10.1007/s00464-022-09348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/20/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surgical intervention is the most accurate method for the treatment of hepatic hemangioma. The advantages of laparoscopic surgery on quality of life should be clarified by prospective studies. METHODS The sample sizes of the laparoscopic and open surgery groups were calculated based on previous retrospective literature. Intraoperative and postoperative parameters were prospectively collected and analyzed. Quality of life in both groups was predicted by a mixed linear model. RESULTS Sixty patients were enrolled in the laparoscopic surgery group and open surgery group. The laparoscopic group had a longer operation time (P = 0.040) and more hospitalization expenses (P = 0.001); however, the Clavien-Dindo classification and comprehensive complication index suggested a lower incidence of surgical complications in the laparoscopic group, with P values of 0.049 and 0.002, respectively. After mixed linear model prediction, between-group analysis indicated that the laparoscopic group had little impact on role-physical functioning and role-emotional functioning; in addition, within-group analysis showed a rapid recovery time on role-physical functioning and role-emotional functioning in the laparoscopic group. Quality of life in both groups recovered to the preoperative level within 1 year after the operation. CONCLUSION The advantages of laparoscopic hepatectomy for hepatic hemangioma were fewer postoperative complications, lower impact on quality of life and faster recovery from affected quality of life.
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Affiliation(s)
- Lian Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Peng Wang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Yonggang Wei
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Mingqing Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Bo Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Ghanaati H, Abrishami A, Hashem Zadeh A, Ghiasi M, Nasiri Toosi M, Jafarian A. Computed Tomography Fluoroscopy-Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma. J Vasc Interv Radiol 2022; 33:1342-1348.e1. [PMID: 35863634 DOI: 10.1016/j.jvir.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 05/24/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of computed tomography (CT) fluoroscopy-guided percutaneous transhepatic sclerotherapy with a bleomycin/ethiodized oil emulsion for symptomatic giant hepatic hemangiomas. MATERIALS AND METHODS The procedure was performed on 22 patients with symptomatic giant hepatic hemangiomas in an outpatient setting between 2018 and 2020. All patients were followed clinically and underwent contrast-enhanced magnetic resonance imaging after 1 month and again at a mean time of 15 months ± 2. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0), in which a severe adverse event was defined as an adverse event with a grade of ≥3. The desired radiologic response (volume and index size) and improvement of pain intensity (visual analog scale [VAS]) and other symptoms were recorded as outcomes. RESULTS Overall, patients showed a 36.4% ± 8.6 reduction in volume and a 14% ± 1.6 reduction in index size after 1 month, with P values of .002 and .001, respectively. The final follow-up volume and index size were 194.7 cm3 ± 25.8 and 77 mm ± 36, respectively. Moreover, a 53.0% ± 7 reduction in volume and 22% ± 3.7 reduction in index size during the final imaging were reported, with the P values of .001 and .001, respectively. Significant reductions in the mean pain intensity (90% of patients with lower VAS scores after intervention) and symptoms were reported. Four patients were classified as clinically unsuccessful, and were recommended further procedures for residual pain. CONCLUSIONS CT fluoroscopy-guided transhepatic sclerotherapy is an effective, safe, and minimally invasive method to manage giant hepatic hemangiomas in an outpatient setting.
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Affiliation(s)
- Hossein Ghanaati
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghiasi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohssen Nasiri Toosi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
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A Comprehensive Review of Hepatic Hemangioma Management. J Gastrointest Surg 2022; 26:1998-2007. [PMID: 35705835 DOI: 10.1007/s11605-022-05382-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs. METHODS A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management. RESULTS HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection. CONCLUSION HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms.
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13
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Jiang B, Shen ZC, Fang XS, Wang XM. Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis. Front Surg 2022; 9:960768. [PMID: 35965862 PMCID: PMC9366102 DOI: 10.3389/fsurg.2022.960768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the safety and efficacy of enucleation and hepatectomy for the treatment of hepatic hemangioma (HH). Methods A systematic literature search was conducted to identify studies evaluating enucleation versus hepatectomy for HH starting from the time of database creation to February 2022. Extraction of the data used in this study was done from the literature. The differences between the two surgical approaches were evaluated by comparing and analyzing the relevant data by means of meta-analysis. Results A total of 1,384 patients (726 underwent enucleation, and 658 with hepatectomy) were included in our meta-analysis from 12 studies. Enucleations were associated with favorable outcomes in terms of operation time [mean difference (MD): −39.76, 95% confidence interval (CI): −46.23, −33.30], blood loss (MD: −300.42, 95% CI: −385.64, −215.19), length of hospital stay (MD: −2.33, 95% CI: −3.22, −1.44), and postoperative complications (OR: 0.57, 95% CI: 0.44–0.74). There were no differences between the groups in terms of patients needing transfusion (OR: 0.85, 95% CI: 0.50, 1.42), inflow occlusion time (MD: 1.72, 95% CI: −0.27, 3.71), and 30-day postoperative mortality (OR: 0.23, 95% CI: 0.02–2.17). Conclusion Compared with hepatectomy, enucleation is found to be effective at reducing postoperative complications, blood loss, and operation time and shortening the length of hospital stay. Enucleation is similar to hepatectomy in terms of inflow occlusion time, 30-day postoperative mortality, and patients needing transfusing to hepatectomy.
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14
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Lin Z, Zhu X, Zhou J. Ultrasound-guided percutaneous sclerotherapy versus surgical resection in the treatment of large hepatic hemangiomas: a retrospective study. BMC Surg 2022; 22:130. [PMID: 35392876 PMCID: PMC8991895 DOI: 10.1186/s12893-022-01574-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is no consensus on the best management for patients with large hepatic hemangiomas. This study was designed to evaluate the efficacy and safety of percutaneous sclerotherapy compared to surgical resection for large hepatic hemangiomas. METHODS A total of 89 patients with large hepatic hemangiomas from single center underwent either percutaneous sclerotherapy (n = 14) or surgical resection (n = 75) as first-line treatment was retrospectively studied, followed up for 9-24 months using ultrasound. Terms of intraoperative and postoperative information, postoperative complications, and treatment effectiveness were compared between the two groups. RESULTS Percutaneous sclerotherapy had shorter operative time (p < 0.001), less blood loss, lower rate of prophylactic abdominal drainage (97.3% vs. 0%, p < 0.001), fewer minor complications (48.0% vs. 7.1%, p < 0.01), shorter hospital stay (p < 0.001), lower hospital cost (p < 0.001), higher Alb level (p < 0.001) and lower postoperative clinical index including ALT, AST and WBC (p < 0.001 for both) than did surgical resection. The major complications were demonstrated no significant difference between the two groups. In addition, the mean maximum cross-sectional areas of hemangioma dropped from 5044.1 ± 2058.0 mm2 to 1924.6 ± 1989.5 mm2 (65.2% reduction) during 9-24 months follow-up (p < 0.001) in the percutaneous sclerotherapy group, while all patients in the surgical resection group achieved complete response. CONCLUSION Percutaneous sclerotherapy is the preferred method for the treatment of large hepatic hemangioma over surgical resection when compared with the items of postoperative recovery, blood loss, complications, hospital stays, and lower hospital costs. The reduction of the maximum cross-sectional area of hepatic hemangioma in the percutaneous sclerotherapy group is satisfactory.
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Affiliation(s)
- Zepeng Lin
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Jian Zhou
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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PEHLİVAN UA, BALLI T, AİKİMBAEV K. Karaciğer dev hemanjiyomlarinin tedavisinde bleomisin ve lipiodol karışımı ile kemoembolizasyonun güvenilirliği ve etkinliği. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1035544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Liu Q, You N, Zhu J, Li J, Wu K, Wang Z, Wang L, Zhu Y, Gu H, Peng X, Zheng L. A Nomogram Model for Predicting the Response to Transcatheter Arterial Embolization in Patients With Symptomatic Hepatic Hemangioma. Front Mol Biosci 2021; 8:722864. [PMID: 34901150 PMCID: PMC8661031 DOI: 10.3389/fmolb.2021.722864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma. Methods: We retrospectively studied 276 patients treated with TAE for hepatic hemangioma at our center from January 2011 to December 2019. The full cohort was randomly divided into training and validation cohorts. After assessing the potential predictive factors for the efficacy of TAE in the training cohort, a nomogram model was established and evaluated by discrimination and calibration. Results: During follow-up, the symptom relief rate was 100%. The tumor blood supply (p < 0.001), tumor number (p = 0.004), and tumor size (p = 0.006) were identified as significant predictors of the failure of tumor shrinkage in response to TAE. The nomogram model showed favorable discrimination and calibration, with a C-index of 0.775 (95% CI, 0.705–0.845) in the training cohort, which was further confirmed in the validation cohort (C-index 0.768; 95% CI, 0.680–0.856). The side effects of TAE were relatively minor and included mainly abdominal pain, nausea, vomiting, fever, and the presence of elevated hepatic transaminases. Conclusion: TAE is a safe and effective treatment for symptomatic hepatic hemangioma. The established nomogram performed well for the estimation of the effect of TAE in patients with hepatic hemangioma and can facilitate the selection of patients who would benefit most from the treatment.
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Affiliation(s)
- Qinqin Liu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China.,Department of Biliary-Pancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Nan You
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jiangqin Zhu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jing Li
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ke Wu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Liang Wang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yinan Zhu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huiying Gu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xuehui Peng
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Lu Zheng
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
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17
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Spontaneous regression of liver hemangiomas: a single-institution analysis of 46 patients. Eur J Gastroenterol Hepatol 2021; 33:1436-1440. [PMID: 33731584 DOI: 10.1097/meg.0000000000002069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to determine the nature of spontaneous regression of liver hemangiomas. PATIENTS AND METHODS The records of the liver hemangioma patients who attended the out-patient clinic between 1988 and 2018 were evaluated. The data of the 716 adult patients who were followed for at least 3 years with cross-sectional imaging were analyzed. RESULTS Spontaneous regression was documented in 46 patients (6.4%). Twenty-eight patients had a single hemangioma (61%), eight (17%) had two hemangiomas; the other 10 patients had 3-6 hemangiomas. Of the 87 lesions in 46 patients, 69 actually regressed during the study. Twelve patients with more than one lesion exhibited discordant courses - one of the hemangiomas of a patient with multiple lesions regressed, whereas the other enlarged or remained stable. Eleven of the regressed hemangiomas exhibited enlargement first, followed by spontaneous regression. Fourteen (20%) of the regressed hemangiomas acquired atypical characteristics that would have suggested a malignancy had the original films been unavailable. CONCLUSION Spontaneous regression of liver hemangiomas is an underrecognized phenomenon. Enlargement should not be a straightforward indication for intervention because it may be followed by regression. A regressed hemangioma should be considered in the differential diagnosis of liver lesions suspicious for malignancy.
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18
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Beristain-Hernández JL, Mora-Muñoz VS, García-Sánchez M. Laparoscopic left lateral segmentectomy secondary to giant liver hemangioma. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021; 86:448-450. [PMID: 34391702 DOI: 10.1016/j.rgmxen.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/20/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- J L Beristain-Hernández
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional "La Raza", Mexico City, Mexico.
| | - V S Mora-Muñoz
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional "La Raza", Mexico City, Mexico
| | - M García-Sánchez
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional "La Raza", Mexico City, Mexico
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19
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Farhat W, Ammar H, Said MA, Mizouni A, Ghabry L, Hammami E, Gupta R, Habiba Ben Hamada, Mabrouk MB, Ali AB. Surgical management of giant hepatic hemangioma: A 10-year single center experience. Ann Med Surg (Lond) 2021; 69:102542. [PMID: 34457247 PMCID: PMC8379432 DOI: 10.1016/j.amsu.2021.102542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic hemangiomas are the most typical benign mesenchymal lesions of the liver. Most of these lesions are asymptomatic. Giant hepatic hemangiomas (GHH) (>10 cm) are often symptomatic and require surgical intervention. This study aimed to describe the clinical findings, risk factors, diagnostic approach and management of GHH. Methods We performed a retrospective analysis of patients with GHH treated at our hospital from January 2008 to December 2018. The medical records of each patient were reviewed to obtain the clinical and surgical data. Results Twelve patients with GHH were treated during the study period. 9 were female and 3 were male. The mean age of diagnosis was 48,2 years. The most common presenting symptom was abdominal pain. Eight patients presented an abdominal mass. Indications for surgical resections were rupture (n = 2), Kasabach-Merritt syndrome (n = 1) and abdominal pain (n = 9). Right hepatectomy was done in four patients, left lobectomy in four patients, and enucleation in four patients. Embolization was performed in 4 patients, but due to the persistence of symptoms or bleeding, surgery was indicated. The mean operative time was 3.5 h, and median blood loss was 870 ml. The median hospital stay was 5.3 days. For four patients, we registered postoperative complications causing death in one case. All alive patients were asymptomatic at a median follow-up of 55 months. Conclusion Despite limitations and alternative modalities, surgery remains the only effective curative treatment for GHH.
Hepatic hemangiomas are the most common benign tumors of the liver with the incidence of 0.4–20%. Giant hepatic hemangiomas (GHH) are usually responsible for overt clinical symptoms and complications. Management of liver hemangiomas ranges from close observation to surgery depending upon the site, size and symptoms. Surgical resection is indicated in patients with abdominal complaints or complications, or when diagnosis remains inconclusive.
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Affiliation(s)
- Waad Farhat
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | | | | | - Linda Ghabry
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Eya Hammami
- Department of Gastroenterology, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Sciences, Synergy Institute of Medical Sciences, Dehradun, India
| | | | | | - Ali Ben Ali
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
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20
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Ayoobi Yazdi N, Mehrabinejad MM, Dashti H, Pourghorban R, Nassiri Toosi M, Rokni Yazdi H. Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma. Radiology 2021; 301:464-471. [PMID: 34402664 DOI: 10.1148/radiol.2021204444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Percutaneous sclerotherapy with bleomycin has been proven to have a potential benefit in the management of low-flow venous malformations. Liver hemangiomas are considered low-flow venous malformations. Thus, percutaneous sclerotherapy could potentially have a promising result in their management. Purpose To investigate the feasibility, efficacy, and safety of percutaneous sclerotherapy with bleomycin in the management of symptomatic giant liver hemangioma (GLH). Materials and Methods This single-institute prospective study was conducted between September 2018 and July 2020. Percutaneous sclerotherapy was performed using a mixture of bleomycin and ethiodized oil under guidance of US and fluoroscopy in participants with GLH who were experiencing related abdominal pain or fullness. Technical success was recorded. Change in symptom severity, according to visual analog scale (VAS), was considered the primary outcome of the study. Volume change, based on the lesion volume at CT, and complications, based on the classification of the Society of Interventional Radiology, were regarded as secondary outcomes. The primary and secondary outcomes were recorded 6 and 12 months after the procedure. Comparison was performed by using the Wilcoxon signed-rank test or paired t test. Results Twenty-eight participants (mean age, 45 years ± 9; 25 women) were evaluated. Technical success was 100%. The mean VAS score was 8.3 before the procedure, which decreased to 1.4 (84.7% reduction) and 1.5 (83.5% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). All participants reported relief of symptoms (17 of 28 participants [61%] with complete relief; 11 [39%] with partial relief) at 12-month follow-up. Mean GLH volumes dropped from 856.3 cm3 to 309.8 cm3 (65.7% reduction) and 206.0 cm3 (76% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). No major complications were detected. Conclusion Percutaneous sclerotherapy is a safe and feasible method with promising results in the treatment of patients with symptomatic giant liver hemangioma. Clinical trial registration no. NCT03649113 © RSNA, 2021 See also the editorial by McGahan and Goldman in this issue.
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Affiliation(s)
- Niloofar Ayoobi Yazdi
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
| | - Mohammad-Mehdi Mehrabinejad
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
| | - Habibollah Dashti
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
| | - Ramin Pourghorban
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
| | - Mohssen Nassiri Toosi
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
| | - Hadi Rokni Yazdi
- From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.)
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Mesny E, Mornex F, Rode A, Merle P. [Radiation therapy of hepatic haemangiomas: Review from a case report]. Cancer Radiother 2021; 26:481-485. [PMID: 34116947 DOI: 10.1016/j.canrad.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/09/2021] [Indexed: 11/18/2022]
Abstract
Haemangioma is the most frequent benign hepatic tumour. Haemangioma is generally asymptomatic but it can sometimes cause disabling symptoms depending on its size and location. Surgery and interventional radiology are the cornerstone of the treatment in this situation. Radiation therapy, already used with good efficacy and safety to treat hepatic malignant lesions as hepatocarcinoma and metastases, is a relevant option in case of contraindication to surgery because of multiple or very large lesions. In this context, we report the case of a patient presenting with multiple symptomatic hepatic haemangiomas, successfully treated by radiation therapy in our department. These good results justified a review of the literature to report series of patients treated in this indication and to describe the main treatment regimens used.
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Affiliation(s)
- E Mesny
- Département de radiothérapie oncologie, groupement hospitalier Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France.
| | - F Mornex
- Département de radiothérapie oncologie, groupement hospitalier Lyon Sud, Hospices civils de Lyon, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Lyon, France
| | - A Rode
- Département de radiologie, groupement hospitalier Lyon Nord, Hospices civils de Lyon, Lyon, France
| | - P Merle
- Université Claude-Bernard Lyon 1, Lyon, France; Département d'hépatologie, groupement hospitalier Lyon Nord, Hospices civils de Lyon, Lyon, France
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22
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Wang A, Chen H, Huang Z, Tang H, Shi H, Wen J, Li Q, Jiang Y, Fu W. Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review. J Int Med Res 2021; 48:300060520976474. [PMID: 33284661 PMCID: PMC7724420 DOI: 10.1177/0300060520976474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Spontaneous internal hemorrhage from a hepatic hemangioma is rare. This case
describes a 59-year-old woman who was hospitalized with recurrent cough and
fever for 6 months. The doctor thought that she had pneumonia, but other
infectious diseases could not be ruled out. Therefore, related tests were
performed and strong antibiotics were used, but the symptom of fever was
persistent and recurred. Enhanced computed tomography (CT) findings showed a
right hepatic giant hemangioma with hemorrhage, while tuberculosis, liver
abscess, and immune disease were excluded by the physician. Because the
patient’s fever was associated with a large hepatic hemangioma, the patient was
transferred to surgery. During treatment, the amount of bleeding increased, so
she underwent a right hepatic hemangioma resection in the emergency department.
Her postoperative fever symptoms subsequently resolved. Pathological examination
confirmed hemorrhagic necrosis with infection in hepatic hemangioma. Follow-up
showed that the patient was afebrile.
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Affiliation(s)
- Ankang Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China.,Department of General Surgery, Nanchong Central Hospital, The second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Zhiwei Huang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hong Tang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hao Shi
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jian Wen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Qiu Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Yu Jiang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
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Xie QS, Chen ZX, Zhao YJ, Gu H, Geng XP, Liu FB. Outcomes of surgery for giant hepatic hemangioma. BMC Surg 2021; 21:186. [PMID: 33832476 PMCID: PMC8033692 DOI: 10.1186/s12893-021-01185-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The surgical indications for liver hemangioma remain unclear. METHODS Data from 152 patients with hepatic hemangioma who underwent hepatectomy between 2004 and 2019 were retrospectively reviewed. We analyzed characteristics including tumor size, surgical parameters, and variables associated with Kasabach-Merritt syndrome and compared the outcomes of laparoscopic and open hepatectomy. Here, we describe surgical techniques for giant hepatic hemangioma and report on two meaningful cases. RESULTS Most (63.8%) patients with hepatic hemangioma were asymptomatic. Most (86.4%) tumors from patients with Kasabach-Merritt syndrome were larger than 15 cm. Enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) were performed through open (87.5%) and laparoscopic (12.5%) approaches. Laparoscopic hepatectomy is associated with an operative time, estimated blood loss, and major morbidity and mortality rate similar to those of open hepatectomy, but a shorter length of stay. 3D image reconstruction is an alternative for diagnosis and surgical planning for partial hepatectomy. CONCLUSION The main indication for surgery is giant (> 10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. For extremely giant hemangiomas, 3D image reconstruction was indispensable. Hepatectomy should be performed by experienced hepatic surgeons.
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Affiliation(s)
- Qing-Song Xie
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Zi-Xiang Chen
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Yi-Jun Zhao
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Heng Gu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Xiao-Ping Geng
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Fu-Bao Liu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China.
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Local Ablation Versus Surgical Resection for Liver Hemangioma: a Systematic Review and Meta-analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Beristain-Hernández JL, Mora-Muñoz VS, García-Sánchez M. Laparoscopic left lateral segmentectomy secondary to giant liver hemangioma. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:S0375-0906(21)00007-0. [PMID: 33771378 DOI: 10.1016/j.rgmx.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J L Beristain-Hernández
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional «La Raza», Ciudad de México, México.
| | - V S Mora-Muñoz
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional «La Raza», Ciudad de México, México
| | - M García-Sánchez
- Clínica de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General, Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional «La Raza», Ciudad de México, México
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Zhang Z, Li JZ, Li HM. Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Revisiting the Surgical Management of Giant Hepatic Hemangiomas: Enucleation Versus Anatomical Resection? J Clin Exp Hepatol 2021; 11:321-326. [PMID: 33994715 PMCID: PMC8103325 DOI: 10.1016/j.jceh.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Resection is rarely indicated in giant hepatic hemangiomas (HHs) that are symptomatic. Enucleation (EN), compared with anatomical resection (AR), is considered the better technique to resect them as EN has been reported to have lower morbidity while conserving the normal liver tissue. But no study has yet clearly established the superiority of EN over AR. In addition, the independent predictors of postoperative morbidity have not been established. METHODS All consecutive patients operated for HH at two specialized hepatobiliary centers were reviewed. Patient demographics, operative variables, and postoperative outcomes were analyzed and compared between two techniques. Postoperative complications were graded as per Clavien-Dindo classification of surgical complications. The aims of this study were to compare two techniques of HH resection with respect to postoperative outcomes and to identify the risk factors for 90-day major postoperative morbidity and mortality. RESULTS A total of 64 patients, including 41 who underwent AR, 22 who underwent EN, and 1 who underwent liver transplantation, were operated for hemangiomas during the study period. Ten patients (9 who were operated for hemangiomas of size ≤4 cm and 1 who underwent transplantation) were excluded. Fifty-four patients, the majority being women (85%), with a median age of 48 years, were operated for giant HH. These patients were classified into two groups based on the technique of resection, namely, EN (22 patients) and AR (32 patients). Both groups were comparable in all aspects except that the number of liver segments resected was significantly more with AR. Postoperative outcomes were similar in both groups. Independent predictors of 90-day major complications including mortality were the use of total vascular exclusion (relative risk [RR]: 2.3, p = 0.028) and duration of surgery >4.5 h (RR: 2.3, p = 0.025). CONCLUSION Both techniques yield similar results with respect to 90-day postoperative morbidity and mortality. The choice of technique should be based on the location of tumor and simplicity of liver resection.
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Giant Liver Hemangiomas: A Plea for Early Surgical Referral and Resection. Case Rep Surg 2020; 2020:5923787. [PMID: 32607273 PMCID: PMC7315262 DOI: 10.1155/2020/5923787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Hepatic hemangiomas are the most common benign hepatic tumor. Current guidelines recommend surveillance imaging and reserving surgical intervention for symptomatic patients with giant liver hemangiomas (>5 cm). We present the case of a patient with a rapidly enlarging giant hepatic hemangioma initially managed by surveillance. During her observation period, she developed weight loss, constipation, and pancytopenia concerning for Kasabach-Merritt Syndrome. Resection of the hemangioma was complicated by its large size (28.0×18.0×11.4 cm). Patients with rapidly growing giant liver hemangiomas, even when asymptomatic, should be promptly referred to specialized surgical centers for evaluation and management.
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Cai WL, Ma XM, Sun XH, Ren T, Huang CY, Li YS, Wang XA, Liu YB, Peng SY. Surgical indication and strategy for liver hemangioma in the caudate lobe: a multi-institutional retrospective analysis with 137 patients. World J Surg Oncol 2020; 18:123. [PMID: 32522218 PMCID: PMC7288691 DOI: 10.1186/s12957-020-01901-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the surgical indication and tactics for liver hemangioma in the caudate lobe Methods From January 1994 to July 2019, 137 patients, including 51 males and 86 females with the average age of 49.2 years old were diagnosed with liver hemangioma in caudate lobe and received treatment at five tertiary referral hospitals. Clinical features, correlations between tumor size and clinical manifestations, treatments, and prognosis were analyzed. Results Of the 137 patients identified, 40 (29.20%) patients were asymptomatic, whereas other 94 patients had clinical symptoms mainly presented as upper abdominal discomfort, epigastric distention, upper abdominal dull pain, nausea, and vomiting. Fifteen (93.75%), 18 (39.13%), and 7 (10.45%) patients presented no clinical symptoms among those tumor size was less than 3 cm (D ≤ 3 cm, n = 16), 3 cm < D ≤ 6 cm (n = 46), and 6 cm < D ≤ 9 cm (n = 67), respectively, while all 8 patients with tumor larger than 9 cm were symptomatic. Tumor diameter was obviously associated with the presence of clinical symptoms. In follow-up period, 7 patients in the conservative group (n = 39) received surgery because of tumor growth or symptom appearance. Totally 105 patients received operation including partial resection or isolated complete resection of caudate lobe and caudate lobe resection combined with liver segment resection, right liver resection, or left liver resection. All operations went smoothly, and no severe complications appeared. Conclusion Tumor diameter was obviously associated with the presence of clinical symptoms in patients with hemangioma in caudate lobe. Surgical therapy is not recommended for asymptomatic patients and available for patient who has symptoms. Effective surgical strategies should be put into use to reduce operative bleeding.
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Affiliation(s)
- Wei Long Cai
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, 198 Hongqi Road, Huzhou, 313003, Zhejiang Province, People's Republic of China
| | - Xiao Ming Ma
- Department of General Surgery, The second affiliated hospital of Soochow University, Suzhou, 215000, Jiangsu Province, People's Republic of China
| | - Xu Heng Sun
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Tai Ren
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Cong Yun Huang
- Department of General Surgery, Yuebei People's Hospital Affiliated to Shantou University School of Medicine, Shaoguan, 512025, Guangdong Province, People's Republic of China
| | - Yong Sheng Li
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Xu An Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Ying Bin Liu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Shu You Peng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
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Tang X, Ding M, Lu B, Chi J, Wang T, Shi Y, Wang Z, Cui D, Li P, Zhai B. Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas. Int J Hyperthermia 2020; 36:632-639. [PMID: 31244349 DOI: 10.1080/02656736.2019.1624837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: Microwave ablation (MWA) has become increasingly popular as a minimally invasive treatment for benign and malignant liver tumors. However, few studies have demonstrated the benefits and disadvantages of MWA compared to surgical resection (SR) for large hepatic hemangiomas. This study aimed to evaluate the safety and effectiveness of MWA compared to SR for large (5-10 cm) hepatic hemangiomas. Methods and materials: This retrospective comparative study included 112 patients with large, symptomatic hepatic hemangiomas who had been treated with MWA (n = 44) or SR (n = 68) and followed up for a median of 44 months using enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Intraoperative information, postoperative recovery time, postoperative discomfort and complications and treatment effectiveness between groups were compared using a chi-square test or an independent t-test. Results: The operative time was significantly shorter (31.3 ± 21.76 versus 148.1 ± 59.3 min, p < .001) and the blood loss (10.2 ± 60.6 versus 227.9 ± 182.9 mL, p < .0001) and rate of prophylactic abdominal drainage [1 (2.3%) versus 57 (83.8%), p < .001] were significantly lower in the MWA group than in the SR group. Postoperative recovery of the MWA group in regard to indwelling catheter time, normal diet time, incision cicatrization time and hospital stay (p < .001) was significantly better than the SR group. However, no statistically significant difference in effectiveness was noted between the groups (p = .58). Conclusions: MWA may be as effective as SR, and potentially safer for treating large, symptomatic hepatic hemangiomas. To confirm our findings, large-sample, multicentered, randomized controlled trials are needed.
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Affiliation(s)
- Xiaoyin Tang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Min Ding
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Bingwei Lu
- b Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jiachang Chi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Tao Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Yaoping Shi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Zhi Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Dan Cui
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Ping Li
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Bo Zhai
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
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Mansour S, Khouri S, Andraous M, Khuri S. Extremely large hemangioma of the liver: Safety of the expectant management. ARCHIVES OF SURGERY AND CLINICAL RESEARCH 2019. [DOI: 10.29328/journal.ascr.1001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review. HPB (Oxford) 2019; 21:1119-1130. [PMID: 30926331 DOI: 10.1016/j.hpb.2019.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of open and minimally invasive liver resection for symptomatic solid benign liver tumours (BLT) such as hepatocellular adenoma, focal nodular hyperplasia and haemangioma is being debated. A systematic review on symptom relief, quality of life (QoL) and surgical outcome after both open and minimally invasive surgery for solid BLT is currently lacking. METHODS A systematic search in PubMed and EMBASE was performed according to the PRISMA guidelines (January 1985-April 2018). Articles reporting pre-and postoperative symptoms or QoL in patients undergoing open or minimally surgery for BLT were evaluated. Methodological quality was assessed using the MINORS tool. RESULTS Forty-two studies were included with 4061 patients undergoing surgery for BLT, 3536 (87%) open and 525 (13%) laparoscopic resections. Randomized and propensity-matched studies were lacking. Symptoms were the indication for resection in 56% of the patients. After a weighted mean of 28.5 months follow-up after surgery, symptoms were relieved in 82% of symptomatic patients. Validated QoL tools were used in eight studies, of which two found significant better QoL scores following laparoscopic compared to open surgery. DISCUSSION Resection of symptomatic BLT seems safe and relieves symptoms in the vast majority of selected patients. Comparative studies are needed before more firm conclusions can be drawn.
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Li X, An C, Liu F, Cheng Z, Han Z, Yu X, Dong L, Yu J, Liang P. The value of 3D visualization operative planning system in ultrasound-guided percutaneous microwave ablation for large hepatic hemangiomas: a clinical comparative study. BMC Cancer 2019; 19:550. [PMID: 31174503 PMCID: PMC6555953 DOI: 10.1186/s12885-019-5682-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the value of a three dimension (3D)visualization operative planning system in ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). Methods Fifty-eight patients with LHHs were divided into 3D and 2D groups. The therapeutic efficacy was assessed by contrast-enhanced imaging during follow-up. Hepatic and renal function were examined. The complete ablation, tumor volume shrinkage, and complication rates were analyzed. Results The ablation time and energy of the 3D group were lower than those of the 2D group (1152.0 ± 403.9 s vs. 1379.7 ± 375.8 s and 87,407.2.9 ± 50,387.0 J vs. 117,775.8 ± 46,245.6 J, P = 0.031 and 0.021, respectively). The 3D group had a higher complete ablation rate than the 2D group (97.7 ± 2.4% vs. 94.5 ± 3.7%, P < 0.001). The incidence of hemoglobinuria after ablation in the 3D group was lower than that in the 2D group (32.0% vs. 57.6%, P = 0.047). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine (Cre) after ablation in the 3D group were lower than those in the 2D group (126.7 ± 56.4 U/L vs. 210.9 ± 96.2 U/L, P < 0.001; 141.0 ± 60.8 U/L vs. 211.4 ± 90.0 U/L, P = 0.001; 57.3 ± 17.6 U/L vs. 80.8 ± 41.9 U/L, P = 0.010; and 66.6 ± 16.6 mmol/L vs. 84.5 ± 39.6 mmol/L, P = 0.037, respectively). There were no significant differences in antenna insertion and the volume reduction rate between the groups. One patient developed acute kidney injury shortly after ablation in the 2D group and recovered after hemodialysis. No other severe complications occurred during the follow-up period. Conclusions The 3D visualization operative planning system has a relatively high clinical application value in providing scientific, reasonable, quantifiable, and individualized therapy for LHHs by US-PMWA.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Linan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Jinhuan Y, Gang D, Binyao S, Huan M, Bin J. Is laparoscopic hepatectomy suitable for giant hepatic hemangioma larger than 10 cm in diameter? Surg Endosc 2019; 34:1224-1230. [PMID: 31161290 DOI: 10.1007/s00464-019-06880-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical treatment of giant hepatic hemangioma larger than 10 cm in diameter often requires major laparoscopic liver resection (LLR), which is very difficult and has a high risk of bleeding. There is no consensus as to whether giant hepatic hemangioma is an indication or a contraindication for laparoscopic surgery. METHODS From 2011/09 to 2018/05, 58 patients with giant hepatic hemangioma larger than 10 cm underwent laparoscopic surgery. They were divided into high-difficulty (HD) group and low-difficulty (LD) group according to the operation difficulty score. The perioperative data of the two groups were analyzed and compared. RESULTS There were 30 patients in the LD group and 28 in the HD group. No differences were showed in sex, age, ASA grade, tumor size, operation time, conversion rate, intraoperative and post-operative blood transfusion rate, and post-operative complications between the two groups. The amount of bleeding in the HD group was significantly higher than that in the LD group (285.7 ± 224.0 vs 189.6 ± 157.6 ml, p = 0.007). The time of hepatic hilar occlusion in the HD group was longer than that in the LD group (25.4 ± 8.8 vs 20.6 ± 7.3 min, p = 0.001), and the rate of hepatic hilar occlusion in the HD group was also higher than that in the LD group (71.4% vs 33.3%, p = 0.004). The incidence of hospitalization days and discharge time in the LD group were shorter than those in the HD group (6.3 ± 1.6 vs 8.2 ± 1.4 days, p = 0.000; 16.4 ± 5.5 vs 21.9 ± 4.6 h, p = 0.019). There was no significant difference in enzymatic parameters between the two groups after operation. CONCLUSIONS Although there are great difficulties and risks objectively, laparoscopic treatment of giant hepatic hemangioma is safe and feasible.
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Affiliation(s)
- Yang Jinhuan
- Liver Surgery Center, Shandong University Qilu Hospital, Jinan, China
| | - Du Gang
- Liver Surgery Center, Shandong University Qilu Hospital, Jinan, China
| | - Shi Binyao
- Liver Surgery Center, Shandong University Qilu Hospital, Jinan, China
| | - Ma Huan
- Liver Surgery Center, Shandong University Qilu Hospital, Jinan, China
| | - Jin Bin
- Liver Surgery Center, Shandong University Qilu Hospital, Jinan, China.
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Abstract
Cystic hepatic lesions are commonly encountered in daily practice. The diagnosis of these lesions ranges from benign lesions of no clinical significance to malignant and potentially lethal conditions. The prevalence of hepatic cyst (HC) has been reported to be as high as 15-18% in the United States. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to characterize further and diagnose. The pre-test probability of a diagnosis is highly affected by the patient's comorbidities and the clinical and laboratory data; thus, imaging studies should be interpreted in the context of the other clinical information for that particular patient. Treatment modalities for hepatic cyst include fenestration, aspiration sclerotherapy, or surgical resection. In the current review, we discuss the pathophysiology, diagnosis, and treatment modalities for various cystic hepatic lesions.
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Chen L, Zhang L, Tian M, Hu Q, Zhao L, Xiong J. Safety and effective of laparoscopic microwave ablation for giant hepatic hemangioma: A retrospective cohort study. Ann Med Surg (Lond) 2019; 39:29-35. [PMID: 30899458 PMCID: PMC6411492 DOI: 10.1016/j.amsu.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/24/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the advantages and disadvantages of laparoscopic microwave ablation (LMWA) as compared with conventional open resection (ORES) for the treatment of giant hepatic hemangioma. Methods and analysis: A retrospective chart review was conduct on patients with hepatic hemangioma underwent LMWA or ORES between 2014 and 2016. Results Of 131 patients, 37 patients underwent ORES and 94 patients underwent LMWA. Blood loss, operative time, postoperative hospital stay, hospital cost (RMB) were significantly different between two groups. Patients after LMWA experienced significantly less pain than those patients undergoing ORES. At a mean follow-up period of 12.8 ± 3.6 months in ORES group and 13.5 ± 2.5 months in LMWA group, no long-term complication was observed. Conclusion Compared with ORES, LMWA is a safe and effective minimally invasive for treating giant hepatic hemangioma.
Retrospectively analysed the clinical data of patients with hepatic haemangioma and investigated the efficacy of operation. Technical aspects of laparoscopic microwave ablation for giant hepatic haemangioma were listed base on operation experience.
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Affiliation(s)
- Libo Chen
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
| | - Lei Zhang
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
- Corresponding author. Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province, 430022, China.
| | - Min Tian
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
| | - Qinggang Hu
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
| | - Lei Zhao
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
| | - Jun Xiong
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430022, China
- Corresponding author.
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Ayoobi Yazdi N, Dashti H, Batavani N, Borhani A, Shakiba M, Rokni Yazdi H. Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study. J Vasc Interv Radiol 2018; 29:233-236. [PMID: 29414196 DOI: 10.1016/j.jvir.2017.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022] Open
Abstract
This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%-71.1% lesion volume reduction and a 12.9%-41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.
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Affiliation(s)
| | - Habibollah Dashti
- Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Batavani
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Borhani
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Rokni Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Wang Z, Tang X, Qi X, Shi Y, Chi J, Li P, Zhai B. Feasibility, safety, and efficacy of ultrasound-guided percutaneous microwave ablation for giant hepatic hemangioma. Int J Hyperthermia 2018; 35:246-252. [PMID: 30130992 DOI: 10.1080/02656736.2018.1493541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hepatic hemangioma is a common benign liver tumor. The majority of cases are asymptomatic and require no specific treatment. The aim of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) for symptomatic or enlarging giant hepatic hemangioma (≥10 cm). METHODS From December 2013 to June 2016, 12 patients with giant hepatic hemangioma (≥10 cm) underwent ultrasound-guided percutaneous MWA, and ablation-related complications were observed. All patients were followed up with magnetic resonance or enhanced CT imaging at one month postoperatively to evaluate efficacy. RESULTS This study included a total of 13 giant hepatic hemangiomas (mean: 11.7 ± 1.6 cm) in 12 patients who initially underwent 16 sessions of MWA; three lesions were treated with two sessions of planned ablation. The average ablation time for a single hepatic hemangioma was 39.0 ± 14.4 minutes. Two patients had acute postoperative non-oliguric renal insufficiency without intra-abdominal hemorrhage, liver failure or other complications. Initially, complete ablation was achieved in ten lesions in nine patients (76.9%, 10/13). One patient underwent a second session of MWA at 5 months postoperatively due to fast growing residual tissue; complete necrosis was achieved after treatment. The remaining two cases did not receive any invasive treatment due to small residual volumes. The total complete ablation rate was 84.6% (11/13). CONCLUSION Image-guided MWA is a safe, feasible, effective treatment for giant hepatic hemangioma; these findings may open a new avenue for treatment.
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Affiliation(s)
- Zhi Wang
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Xiaoyin Tang
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Xingxing Qi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Yaoping Shi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Jiachang Chi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Ping Li
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Bo Zhai
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
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Liu F, Yu X, Cheng Z, Han Z, Dou J, Yu J, Liang P. Risk factors for hemoglobinuria after ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous hemangiomas. Oncotarget 2018; 9:25708-25713. [PMID: 29876018 PMCID: PMC5986649 DOI: 10.18632/oncotarget.25379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/29/2017] [Indexed: 01/26/2023] Open
Abstract
Thermal ablation of large hepatic cavernous hemangiomas may lead to intravascular hemolysis, hemoglobinuria, and even acute renal failure. This study aimed to identify the risk factors associated with hemoglobinuria after ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous hemangiomas. In our study, 11 related risk factors were analyzed using univariate and multivariate binary logistic regression model and Receiver operating characteristic curves to determine the contribution to hemoglobinuria after microwave ablation for 49 patients with 51 hepatic cavernous hemangiomas. By multivariate analysis, the ablation time (p = 0.021; Odds Ratio, 1.005), and the number of antenna insertions (p = 0.036; Odds Ratio, 3.568) were the independent risk factors associated with hemoglobinuria. The cutoff value for ablation time and the number of antenna insertions in predicting the presence of hemoglobinuria was 1185s (sensitivity, 75%; specificity, 69%) and 4.5 (sensitivity, 55%; specificity, 83%), respectively. Less than 5 of antenna insertions and less than 20 mins of ablation time may therefore be recommended in patients with microwave ablation of large hepatic cavernous hemangiomas, in order to reduce the occurrence of hemoglobinuria. This is the first report about the risk factors analysis associated with hemoglobinuria after thermal ablation for large hepatic cavernous hemangiomas.
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Affiliation(s)
- Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853 China
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Superselective Transarterial Chemoembolization as an Alternative to Surgery in Symptomatic/Enlarging Liver Hemangiomas. World J Surg 2018. [PMID: 28634838 DOI: 10.1007/s00268-017-4069-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transarterial embolization of liver hemangiomas has not been considered to be consistently effective. METHODS The charts of 25 patients who underwent superselective transarterial chemoembolization with the bleomycin-lipiodol emulsion were evaluated retrospectively. RESULTS Twenty-two patients had abdominal pain; asymptomatic/vaguely symptomatic enlargement was the treatment indication in three patients. A single session was conducted in 17 patients, two sessions in 7 and three sessions in one. After the first session, lesion volume decreased by median (range) 51% (10-92%) from median (range) 634 (226-8435) to 372(28-4710) cm3 (p < 0.01), after a median period of 4 months (range 2-8). A second session was performed in eight patients (median (range) initial volume 1276 (441-8435) cm3) with persistent complaints and/or large lesions receiving feeders from both right and left hepatic arteries (staged treatment). Median (range) lesion size decreased further from 806 (245-4710) to 464 (159-2150) cm3 (p < 0.01). Three patients experienced a postembolization syndrome that persisted after the first week. Seventeen of the 22 symptomatic patients (77%) reported resolution or marked amelioration of complaints. Regrowth after initial regression was not observed during median (range) 14 (8-39) months of follow-up (n:18). CONCLUSION Transarterial chemoembolization with the bleomycin-lipiodol emulsion is a potential alternative to surgery for symptomatic/enlarging liver hemangiomas. Volume reduction is universal, and symptom control is satisfactory. Centrally located and very large (>1000 cm3) lesions may require two sessions.
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Wen SQ, Wan M, Len KM, Hu QH, Xie XY, Wu Q, Liao GQ. Safety and Efficacy of Laparoscopic Radiofrequency Ablation for Hepatic Hemangiomas: A Multicenter Retrospective Study. Ann Hepatol 2018; 17:268-273. [PMID: 29469049 DOI: 10.5604/01.3001.0010.8653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is an effective and minimally invasive technique for the management of hepatic hemangiomas (HHs). This study aims to assess the safety and efficacy of laparoscopic RFA for HHs. MATERIAL AND METHODS Forty-four patients with 50 hepatic hemangiomas (5-10 cm in diameter) undergoing laparoscopic RFA from January 2012 to May 2015 at three tertiary hospitals in China were retrospectively analyzed. RESULTS Thirty-three patients with subcapsular hemangiomas were treated with a laparoscopic approach, and 11 patients with lesions in the liver parenchyma were treated with a combined laparoscopy and an ultrasound-guided percutaneous approach. No conversion to open surgery or two-step surgery occurred during the study period. Patients with small hemangiomas (< 7 cm) required a significantly shorter operating time (71.1 ± 20.18 min vs. 106 ± 23.55 min, p = 0.000) and fewer punctures compared with patients with large hemangiomas (> 7 cm) (4.61 ± 1.09 vs. 6.73 ±1.01, P < 0.05). According to the Dindo-Clavien classification, 15 patients experienced 34 Grade 1 complications, and two had complications of Grade 3a. All complications were resolved by conservative treatment. Forty-three (86.0%) HHs in 38 patients were completely ablated after RFA, and 7 (14.0%) HHs in 6 patients were incompletely ablated. All patients were followed up for 6-24 months (mean 15 ± 6 months). CONCLUSION The data showed that laparoscopic RFA is an effective treatment for small (< 10 cm) HHs. While the incidence of postoperative complications remains high, the majority of complications are minor. Patients undergoing laparoscopic RFA for HHs, even for the small ones, should be carefully selected.
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Affiliation(s)
- Shun-Qian Wen
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Ming Wan
- Department of General Surgery, the Second Hospital affiliated to Harbin Medical University, Harbin 150000, China
| | - Kai-Ming Len
- Department of General Surgery, the Second Hospital affiliated to Harbin Medical University, Harbin 150000, China
| | - Qiu-Hui Hu
- the Second Cancer Hospital of Heilongjiang Province, Harbin 150000, China. Department of Hepatobiliary Surgery
| | - Xue-Yi Xie
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Qing Wu
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Guan-Qun Liao
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
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Boukerrouche A. Therapeutic Options of Giant Liver Hemangioma. JOURNAL OF LIVER RESEARCH, DISORDERS & THERAPY 2018. [DOI: 10.15406/jlrdt.2018.04.00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Kirnap M, Boyvat F, Boyacioglu S, Hilmioglu F, Moray G, Haberal M. The Effect of Bleomycin Embolization on Symptomatic Improvement and Hemangioma Size among Patients with Giant Liver Hemangiomas. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojgas.2018.84014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kirnap M, Boyvat F, Boyacioglu S, Hilmioglu F, Moray G, Haberal M. The effect of bleomycin embolization on symptomatic improvement and hemangioma size among patients with giant liver hemangiomas. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Patient age affects the growth of liver haemangioma. HPB (Oxford) 2018; 20:64-68. [PMID: 28927653 DOI: 10.1016/j.hpb.2017.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to report the prevalence of liver haemangioma and describe growth rates by age. METHODS A retrospective study of people undergoing a health examination. The collected data included gender, age, presence or absence and size of liver haemangioma. A second database of liver haemangioma patients with a minimum follow up period of 5 years was analysed. The collected data included gender, initial age at diagnosis, follow-up period, initial and final size. RESULTS Patients were divided into four age groups: 20-29 years, 30-39 years, 40-49 years and ≥50 years. Patients in the 20-29 years group had the lowest prevalence of liver haemangioma (1.78%) and the smallest size (1.3 ± 0.7 cm), while 40-49 years group had the highest prevalence (3.94%) and largest size (1.9 ± 1.3 cm). Patients between 30 and 39 years had the greatest increase in haemangioma size (4.0 cm, (3.0, 6.0) cm), while patients of ≥50 years had the least (1.4 cm (0.5, 3.8) cm). The proportion of patients without an increase in haemangioma size increased with age (P = 0.031). CONCLUSION Age is an important factor affecting the prevalence and growth rate of liver haemangioma.
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Liu X, Yang Z, Tan H, Huang J, Xu L, Liu L, Si S, Sun Y. Long-term result of transcatheter arterial embolization for liver hemangioma. Medicine (Baltimore) 2017; 96:e9029. [PMID: 29245292 PMCID: PMC5728907 DOI: 10.1097/md.0000000000009029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transcatheter arterial embolization (TAE) is a method for the treatment of liver hemangioma, but fewer studies reported the long-term result.Retrospective study was conducted to liver hemangioma patients who received TAE. The inclusion criteria included the following: the period of follow-up was more than 5 years; and patients were followed up for less than 5 years, but received surgical treatment due to the enlargement of tumor or severe complications of TAE. The collected data included sex, age, size of the tumor, times of TAE, complications, period of follow-up, long-term result, and whether or not surgery was finally performed.Fifty-five patients were included, and the average age was 43.1 ± 8.6 years. The average size of liver hemangioma was 9.0 ± 4.3 cm. Four patients (7.3%) had severe complications after TAE, including 2 cases of biloma which were cured by surgery. The tumor size was smaller or the same in 19 patients after 5 years follow-up, and the long-term effective rate was 35.8%. The size of tumor became larger in the other 34 patients (64.2%), and 29 patients (54.7%) received surgery finally. The long-term effective rate for patients with ≥10 cm tumor and <10 cm tumor were 12.5% and 45.9%, respectively, and the difference was significant (P = .019).The long-term result of TAE for liver hemangioma was not satisfying, and the treatment had the risk of severe complication. For patients with asymptomatic liver hemangioma, TAE should not be conducted.
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Location affects the management of liver haemangioma: A retrospective cohort study. Int J Surg 2017; 48:110-115. [PMID: 29032158 DOI: 10.1016/j.ijsu.2017.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/29/2017] [Accepted: 10/06/2017] [Indexed: 01/02/2023]
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Liu F, Yu X, Liang P, Cheng Z, Han Z, Yu J. Ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous haemangiomas. Int J Hyperthermia 2017; 34:1061-1066. [PMID: 29025295 DOI: 10.1080/02656736.2017.1392045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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50
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Gao J, Fan RF, Yang JY, Cui Y, Ji JS, Ma KS, Li XL, Zhang L, Xu CL, Kong XL, Ke S, Ding XM, Wang SH, Yang MM, Song JJ, Zhai B, Nin CM, Guo SG, Xin ZH, Lu J, Dong YH, Zhu HQ, Sun WB. Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts. World J Gastroenterol 2017; 23:7077-7086. [PMID: 29093616 PMCID: PMC5656455 DOI: 10.3748/wjg.v23.i39.7077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023] Open
Abstract
Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.
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Affiliation(s)
- Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Rui-Fang Fan
- Department of Hepatobiliary Surgery, Lanzhou General Hospital of Lanzhou Military Region, Lanzhou 730050, Gansu Province, China
| | - Jia-Yin Yang
- Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Cui
- Department of General Surgery, the 306th Hospital of Chinese People’s Liberation Army, Beijing 100012, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Wenzhou 32300, Zhejiang Province, China
| | - Kuan-Sheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Xiao-Long Li
- Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Long Zhang
- Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Chong-Liang Xu
- Department of Hepatobiliary Surgery, Rizhao People’s Hospital, Rizhao 276801, Shandong Province, China
| | - Xin-Liang Kong
- Department of Hepatobiliary Surgery, Rizhao People’s Hospital, Rizhao 276801, Shandong Province, China
| | - Shan Ke
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Xue-Mei Ding
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Shao-Hong Wang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Meng-Meng Yang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Jin-Jin Song
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Wenzhou 32300, Zhejiang Province, China
| | - Bo Zhai
- Department of Tumor Intervention, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Chun-Ming Nin
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
| | - Shi-Gang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
| | - Zong-Hai Xin
- Department of General Surgery, Zhanhua People’s Hospital, Zhanhua 256800, Shandong Province, China
| | - Jun Lu
- Department of General Surgery, Shandong Provincial People’s Hospital, Jinan 250021, Shandong Province, China
| | - Yong-Hong Dong
- Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan 032200, Shanxi Province, China
| | - Hua-Qiang Zhu
- Department of General Surgery, Shandong Provincial People’s Hospital, Jinan 250021, Shandong Province, China
| | - Wen-Bing Sun
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
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