Treatment of giant hemangiomas of the liver by enucleation

Cavernous hemangiomas are the most common benign tumors of the liver. The results of natural history studies have demonstrated that asymptomatic hemangiomas can be observed without deleterious results. The appropriate treatment for symptomatic cavernous hemangiomas remains unclear. Since 1987, ten patients with symptomatic giant cavernous hemangiomas have undergone simple enucleation at the New England Deaconess Hospital, Boston, Massachusetts. Ten patients who underwent both anatomic and nonanatomic resections for benign hepatic tumors were chosen as a control group. We analyzed patient demographics and characteristics of the hospital course. Both groups had similar periods of hospitalization (9.5 +/- 1.2 versus 9.1 +/- 1.8 days; p = NS), operative time (2.2 +/- 0.3 versus 2.4 +/- 0.2 hours; p = NS) and lesion size (7.6 +/- 1.3 versus 8.4 +/- 1.2 centimeters; p = NS). The enucleation group had 49 percent less intraoperative blood loss when compared with the resection group (400 +/- 129 versus 742 +/- 116 milliliters; p < 0.05). Two units of blood were transfused in the enucleation group while 6 units were transfused in the resection group. Postoperatively, two patients in the resection group required computed tomographic guided drainage of extrahepatic bile collections. There were none in the enucleation group. Because enucleation is performed in the fibrous capsule composed of compressed hepatic parenchyma, injury to major bile ducts and blood vessels may be avoided. Enucleation is a safe alternative to resection for treatment of symptomatic giant hemangiomas.