MANAGEMENT AND FOLLOW-UP OF 78 GIANT HEMANGIOMAS OF THE LIVER

The natural history and appropriate treatment of giant liver haemangio ma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered int o a follow-up programme consisting of clinical assessment and abdomina l ultrasonography every 6 months. Resection was considered only for sy mptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean followup was 36 months for the resected patients and 55 mont hs for the observed group. Surgery permanently relieved symptoms. No r ecurrence of haemangioma was observed. Some 32 of 36 unresected lesion s followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a f urther indication for resection and justifies strict imaging follow-up . The pattern of growth, rather than absolute size, of a lesion is sug gested for selection of asymptomatic patients who might benefit from p reventive surgical excision. When feasible, the authors prefer enuclea tion to remove giant haemangiomas.