Reconsideration of the clinical management of hepatic hemangioma

Table 1 Surgical indications for hepatic hemangioma

Ref.	Years	Type	Surgical indications
Miura et al[15]	2014	Multicenter retrospective study	Abdominal discomfort; Strong intention of surgery caused by anxiety; Tumor enlargement; Life-threatening complications (traumatic rupture)
Marrero et al[16]	2014	Clinical guideline	Diameter > 10 cm; Symptoms of compression; Recurrent abdominal pain
Strauss et al[17]	2015	Clinical recommendation	Large hemangioma with compression symptoms; Rare complications (tumor rupture); Kasabach-Merritt syndrome
European Association for the Study of the Liver (EASL)[18]	2016	Clinical guideline	Tumor enlargement; Symptoms of compression; Kasabach-Merrit syndrome
Yuan et al[25]	2022	Observational study	Only severe complications (Kasabach-Merritt syndrome, spontaneous rupture, obstructive jaundice, gastric outlet obstruction, Budd-Chiari syndrome)

Table 2 Efficacy of transcatheter arterial embolization or transarterial chemoembolization for hepatic hemangioma

Ref.	Years	Type	Treatment	Efficacy
Özgür and Sindel[24]	2021	Retrospective study	TAE vs TACE	TACE is superior to TAE in reducing hepatic hemangioma volume and pain
Yuan et al[25]	2022	Retrospective study	TACE	At follow-up ≥ 5 years, 86.5% of hepatic hemangiomas had a maximum postoperative diameter reduction of more than 50%
Kacała et al[26]	2023	Retrospective study	TACE	77.5% of the patients with hepatic hemangioma embolism rate more than 75%
Kacała et al[27]	2024	Retrospective study	TACE	The volume of hepatic hemangioma was reduced by more than 50% in 80.6% of patients
Zhao D et al[28]	2024	Multicenter retrospective study	TACE	The volume of tumor was reduced by more than 50% in 80.7% of hepatic hemangiomas

TAE: Transarterial embolization; TACE: Transarterial chemoembolization.

Table 3 Efficacy of ablation for hepatic hemangioma

Ref.	Years	Type	Treatment	Efficacy
Wen et al[29]	2018	Multicenter retrospective study	RFA	Complete ablation was achieved in 86% of hepatic hemangiomas
Shi et al[30]	2020	Multicenter retrospective study	TAE vs MWA	Microwave ablation was associated with higher rates of radiological complete response (89.0% vs 37.7%) and clinical complete response (88.6% vs 69.2%), fewer minor complications (43.9% vs 66.0%), shorter duration of analgesic drug use and hospital stay
Wu et al[31]	2021	Multicenter retrospective study	RFA	Complete ablation was achieved in 99% of hepatic hemangiomas
Kong et al[32]	2022	Multicenter retrospective study	MWA vs RFA	Microwave ablation was associated with shorter ablation duration, fewer hemolysis-related complications, and shorter hospital stays
Xu et al[33]	2023	Multicenter retrospective study	RFA	Complete ablation was achieved in 95.5% of hepatic hemangiomas. Preoperative symptoms disappeared completely in 96.4% of the patients. During follow-up, 11.4% of patients with hemangioma close to completely disappear over time
Cai et al[35]	2024	Multicenter retrospective study	MWA vs percutaneous sclerotherapy	Microwave ablation has a lower local tumor progression rate, higher volume reduction rate, and symptom remission rate

RFA: Radiofrequency ablation; TAE: Transarterial embolization; MWA: Microwave ablation.