Long-term results of surgery for liver hemangiomas

Background: Elective surgery for liver hemangiomas is still controversial. Hypothesis: Long-term results show that elective surgery for liver hemangio mas is safe and effective. Setting: A tertiary care university hospital in Istanbul, Turkey. Patients: Forty-two patients underwent surgery for liver hemangiomas betwee n January 1988 and December 1998; 41 were symptomatic. The primary indicati ons for surgery were abdominal pain in 33 patients, diagnostic uncertainty in 6, and enlargement in 3. The median largest dimension of the major lesio n was 10 cm (range, 7-45 cm). Main Outcome Measures: (1) Patients' assessment of the effects of surgery o n preoperative symptoms, (2) determination of whether any other pathologica l conditions were missed in the preoperative evaluation, (3) operative mort ality and morbidity, and (4) recurrences. Design: Retrospective cohort study. Results: Enucleation was the most frequent operation (33 patients). Hospita l mortality and morbidity were 2.4% (bleeding from the biopsy site on a les ion evaluated as inoperable at laparotomy; 1 patient) and 12% (5 patients), respectively. Thirty-three patients could be followed up for a median of 5 3 months (range, 6-135 months). Of the 32 preoperatively symptomatic patien ts, surgery was successful in symptom control in 28 (88%) (complete resolut ion or significant amelioration). No other cause of pain could be identifie d during follow-up in the other patients. Control ultrasonography revealed no recurrences. Conclusions: Elective surgery is indicated in a small subset of patients wi th hemangiomas because of abdominal pain, enlargement, and diagnostic uncer tainty. The results of surgery in symptom control are gratifying in approxi mately 90% of patients. Recurrences are rare. Enucleation can be performed rapidly and safely in most patients and should be preferred to resection.