Ann Hepatobiliary Pancreat Surg.  2020 May;24(2):137-143. 10.14701/ahbps.2020.24.2.137.

Feasibility of laparoscopic liver resection for liver cavernous hemangioma: A single-institutional comparative study

• Shin Y
• Rhu J
• Choi GS
• Kim JM
• Joh JW
• Kwon CHD

• KMID: 2500773
• DOI: http://doi.org/10.14701/ahbps.2020.24.2.137

Abstract

Backgrounds/Aims
While minimal invasive surgery has become popular, the feasibility of laparoscopy for liver cavernous hemangioma has not been shown.
Methods
Patients who underwent hepatectomy for liver cavernous hemangioma from January 2008 to February 2019 at the Samsung Medical Center were reviewed. Patients who underwent trisectionectomy were excluded. Background characteristics, along with operative and postoperative recovery, were compared between the laparoscopy and open surgery groups.
Results
Forty-three patients in the laparoscopy group and 33 patients in the open surgery group were compared. The differences in the background characteristics were presence of symptoms (14.6% in laparoscopy vs. 57.1% in open, p＜0.001) and tumor location (right, left and both side p=0.017). The laparoscopy group had smaller blood loss (p=0.001), lesser blood transfusion requirements (p=0.035), lower level of post-operative total bilirubin, prothrombin time (INR) (p=0.001, 0.003 each), shorter hospital stay (p=0.001), earlier soft diet start (p＜0.001), earlier drain removal (p＜0.001) and shorter amount and duration of additional pain control (p=0.001, p=0.017 each). There was no significant difference in complication after surgery between two groups (p=0.721). All the patients showed pathologic report of benign hemangioma regardless of type of surgery (100%). Almost every patients reported no symptom or relief of symptom in both groups (97.7%, 93.9% each).
Conclusions
Laparoscopic liver resection for liver cavernous hemangioma can be safely performed with improved postoperative recovery. However, surgery for liver cavernous hemangioma should be conducted with informed consent of the patients.

Keyword

Hemangioma; Laparoscopy; Laparoscopic liver resection; Cavernous hemangioma

Reference

1. Cho CW, Rhu J, Kwon CHD, Choi GS, Kim JM, Joh JW, et al. 2017; Short-term outcomes of totally laparoscopic central hepatectomy and right anterior sectionectomy for centrally located tumors: a case-matched study with propensity score matching. World J Surg. 41:2838–2846. DOI: 10.1007/s00268-017-4105-5. PMID: 28752429.

2. Rhu J, Kim SJ, Choi GS, Kim JM, Joh JW, Kwon CHD. 2018; Laparoscopic versus open right posterior sectionectomy for hepatocellular carcinoma in a high-volume center: a propensity score matched analysis. World J Surg. 42:2930–2937. DOI: 10.1007/s00268-018-4531-z. PMID: 29426971.

3. Wakabayashi G. 2016; What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr. 5:281–289. DOI: 10.21037/hbsn.2016.03.03. PMID: 27500140. PMCID: PMC4960417.

4. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. 2015; Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 261:619–629.

5. Jung KU, Kim HC, Cho YB, Kwon CH, Yun SH, Heo JS, et al. 2014; Outcomes of simultaneous laparoscopic colorectal and hepatic resection for patients with colorectal cancers: a comparative study. J Laparoendosc Adv Surg Tech A. 24:229–235. DOI: 10.1089/lap.2013.0475. PMID: 24571378.

6. Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, et al. 2018; Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant. 18:434–443. DOI: 10.1111/ajt.14455. PMID: 28787763.

7. Soubrane O, Goumard C, Laurent A, Tranchart H, Truant S, Gayet B, et al. 2014; Laparoscopic resection of hepatocellular carcinoma: a French survey in 351 patients. HPB (Oxford). 16:357–365. DOI: 10.1111/hpb.12142. PMID: 23879788. PMCID: PMC3967888.

8. Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, et al. 2010; Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc. 24:1170–1176. DOI: 10.1007/s00464-009-0745-3. PMID: 19915908.

9. Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, et al. 2017; Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann Surg. 265:856–863. DOI: 10.1097/SLA.0000000000002072. PMID: 27849661.

10. Brouwers MA, Peeters PM, de Jong KP, Haagsma EB, Klompmaker IJ, Bijleveld CM, et al. 1997; Surgical treatment of giant haemangioma of the liver. Br J Surg. 84:314–316. DOI: 10.1002/bjs.1800840310. PMID: 9117293.

11. van Malenstein H, Maleux G, Monbaliu D, Verslype C, Komuta M, Roskams T, et al. 2011; Giant liver hemangioma: the role of female sex hormones and treatment. Eur J Gastroenterol Hepatol. 23:438–443. DOI: 10.1097/MEG.0b013e328345c87d. PMID: 21399504.

12. Kim IS, Kwon CH. 2014; Feasibility of laparoscopic liver resection for giant hemangioma of greater than 6 cm in diameter. Korean J Hepatobiliary Pancreat Surg. 18:118–121. DOI: 10.14701/kjhbps.2014.18.4.118. PMID: 26155263. PMCID: PMC4492351.

13. Bai DS, Chen P, Qian JJ, Yao J, Jin SJ, Wang XD, et al. 2015; Modified laparoscopic hepatectomy for hepatic hemangioma. Surg Endosc. 29:3414–3421. DOI: 10.1007/s00464-014-4048-y. PMID: 25552235.

14. Giulianotti PC, Addeo P, Bianco FM. 2011; Robotic right hepatectomy for giant hemangioma in a Jehovah's Witness. J Hepatobiliary Pancreat Sci. 18:112–118. DOI: 10.1007/s00534-010-0297-x. PMID: 20596878.

15. Yu HB, Dong YD, Wang LC, Tian GJ, Mu SM, Cao Y, et al. 2015; Laparoscopic versus open resection for liver cavernous hemangioma: a single center of 2-year experience. Surg Laparosc Endosc Percutan Tech. 25:e145–e147. DOI: 10.1097/SLE.0000000000000196. PMID: 26429056.

16. Ji J, Gao J, Zhao L, Tu J, Song J, Sun W. 2016; Computed tomography-guided radiofrequency ablation following transcatheter arterial embolization in treatment of large hepatic hemangiomas. Medicine (Baltimore). 95:e3402. DOI: 10.1097/MD.0000000000003402. PMID: 27082617. PMCID: PMC4839861.

17. Gao J, Ding X, Ke S, Xin Z, Ning C, Sha Q, et al. 2014; Radiofrequency ablation in the treatment of large hepatic hemangiomas: a comparison of multitined and internally cooled electrodes. J Clin Gastroenterol. 48:540–547. DOI: 10.1097/MCG.0b013e31829ef037. PMID: 24926624.

18. Liu L, Li N. 2014; Feasibility and advantages of large liver hemangioma treated with laparoscopic microwave ablation. Hepatogastroenterology. 61:1068–1073.

19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. 2009; The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 250:187–196. DOI: 10.1097/SLA.0b013e3181b13ca2. PMID: 19638912.

20. Pulvirenti E, Toro A, Di Carlo I. 2010; An update on indications for treatment of solid hepatic neoplasms in noncirrhotic liver. Future Oncol. 6:1243–1250. DOI: 10.2217/fon.10.85. PMID: 20799871.