Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 25;10(19):4381.
doi: 10.3390/jcm10194381.

The Two-Step Treatment for Giant Hepatic Hemangiomas

Angelo Della Corte  1   2   3 , Rebecca Marino  4 , Francesca Ratti  4 , Diego Palumbo  1   2   3 , Giorgia Guazzarotti  1 , Simone Gusmini  1 , Luigi Augello  1 , Federica Cipriani  4 , Guido Fiorentini  4   5 , Massimo Venturini  6 , Luca Aldrighetti  3   4 , Francesco De Cobelli  1   2   3
Affiliations

The Two-Step Treatment for Giant Hepatic Hemangiomas

Angelo Della Corte et al. J Clin Med. .

Abstract

The aim of the present study is to analyze the feasibility and the impact of a two-step approach in the treatment of giant hemangiomas (GH) i.e., exceeding 10 cm in maximum diameter, consisting of transarterial embolization (TAE) followed by laparoscopic liver resection (LLR). Ten patients with 11 GH were treated with TAE and subsequent LLR between 2017 and 2020 (Group A). A matched cohort of 10 patients with GH treated with upfront LLR between 2014 and 2017 was identified for comparison (Group B). Data were analyzed regarding intraoperative and postoperative outcomes, including successful completion of LLR, morbidity, and mortality. Successful microparticle embolization of the GH-feeding arteries was performed in all patients in group A. In three cases a liquid embolic agent (Squid-18) was also injected to obtain complete embolization. No complications were observed after TAE. Successful surgery was performed after a mean time interval of 2.2 days from TAE without any case of conversion to laparotomy. Statistically significant differences between group A and group B were found in intraoperative blood loss (250 ± 200 vs. 400 ± 300 mL, p = 0.039), operative time (245 ± 60 vs. 420 ± 60 min, p = 0.027), and length of stay (5 ± 1 vs. 8 ± 2 days, p = 0.046). Our data suggest that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH >10 cm.

Keywords: giant hepatic hemangioma; laparoscopic surgery; radiologic arterial embolization.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
On preoperative CT (a), a giant hemangioma of the right liver lobe is identified, with evidence of vascular afference from the right phrenic artery (arrow). On angiography, after identification and embolization of the right hepatic artery (b), right phrenic artery is selectively catheterized and embolized with microparticles (c).
Figure 1
Figure 1
On preoperative CT (a), a giant hemangioma of the right liver lobe is identified, with evidence of vascular afference from the right phrenic artery (arrow). On angiography, after identification and embolization of the right hepatic artery (b), right phrenic artery is selectively catheterized and embolized with microparticles (c).
Figure 2
Figure 2
Pre- and post-embolization angiography. A giant hemangioma with vascular afference from the left hepatic artery originating independently from the celiac trunk is identified (a). Embolization is performed with microparticles and Squid 18 to achieve complete lesion devascularization (b).
Figure 2
Figure 2
Pre- and post-embolization angiography. A giant hemangioma with vascular afference from the left hepatic artery originating independently from the celiac trunk is identified (a). Embolization is performed with microparticles and Squid 18 to achieve complete lesion devascularization (b).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bo Y.C., Nguyen M.H. The diagnosis and management of benign hepatic tumors. J. Clin. Gastroenterol. 2005;39:401–412. doi: 10.1097/01.mcg.0000159226.63037.a2. - DOI - PubMed
    1. Toro A., Mahfouz A.E., Ardiri A., Malaguarnera M., Malaguarnera G., Loria F., Bertino G., Carlo I. Di What is changing in indications and treatment of hepatic hemangiomas. A review. Ann. Hepatol. 2014;13:327–339. doi: 10.1016/S1665-2681(19)30839-7. - DOI - PubMed
    1. Xie Q.S., Chen Z.X., Zhao Y.J., Gu H., Geng X.P., Liu F.B. Outcomes of surgery for giant hepatic hemangioma. BMC Surg. 2021;21:186. doi: 10.1186/s12893-021-01185-4. - DOI - PMC - PubMed
    1. Donati M., Stavrou G.A., Donati A., Oldhafer K.J. The risk of spontaneous rupture of liver hemangiomas: A critical review of the literature. J. Hepatobiliary Pancreat. Sci. 2011;18:797–805. doi: 10.1007/s00534-011-0420-7. - DOI - PubMed
    1. Wakabayashi G., Cherqui D., Geller D.A., Buell J.F., Kaneko H., Han H.S., Asbun H., O’Rourke N., Tanabe M., Koffron A.J., et al. Recommendations for laparoscopic liver resection: A report from the second international consensus conference held in morioka. Ann. Surg. 2015;261:619–629. doi: 10.1097/SLA.0000000000001184. - DOI - PubMed

LinkOut - more resources

-