Hypothesis: Patient outcome and the development of major intra-abdominal po
stoperative complications following removal of cavernous hemangiomas of the
liver are affected by methods of resection.
Design: Case-control study.
Setting: Hepatobiliary surgery and liver transplantation unit in a tertiary
care referral medical center.
Patients: Between December 1, 1987, and December 1, 1997, 28 patients under
went the surgical removal of cavernous hemangioma either by hepatic resecti
on or enucleation. Indications for the operation were pain, enlarging tumor
s, uncertain diagnosis, or rupture.
Main Outcome Measures: The technique of tumor removal, hospital course, and
the development of intra-abdominal complications. Independent factors infl
uencing the development of complications were ascertained by multivariate a
nalysis.
Results: Twenty-four female and 4 male patients (age, 47.5 +/- 12.4 [mean /- SD] years) underwent either enucleation (n=23) or liver resection (n=5).
Lesions ranged from 2 to 16 cm in their postresection diameter. No surgica
l (30-day) mortality was observed. Four major intra-abdominal complications
were found: 1 episode of intraoperative bleeding requiring abdominal packi
ng and 3 intra-abdominal fluid collections requiring percutaneous drainage.
Enucleation was the only independent factor found by univariate and multiv
ariate analyses to be associated with a reduction in the number of intra-ab
dominal complications (P=.04).
Conclusions: Cavernous hemangiomas of the liver can be removed safely by ei
ther hepatic resection or enucleation. Enucleation is associated with fewer
intra-abdominal complications and should be the technique of choice when t
umor location and technical factors favor enucleation.