Introduction: Hemangiomas are the most common benign tumors of the liver. There are two main methods for surgical treatment of hepatic hemangiomas: liver resections of different sizes and enucleation. To date, there is no consensus on the surgical treatment of benign liver tumors, including hemangiomas.
Objective: To make a comparative analysis of the results obtained in the surgical treatment of LH, focusing on the two main methods of resection and enucleation.
Materials and methods: For the period 2006 - 2018, 101 patients with LH were operated on in the surgery clinics of the Military Medical Academy, and 111 tumors were removed. 84 resections and 27 enucleations were performed. The influence of the operative procedure on the operative factors: blood loss, operative time, postoperative period and complications, as well as the influence of the size and localization on the choice of operative procedure are analyzed.
Results: 84 resections (63 anatomical and 21 atypical) and 27 enucleations (18 ideal and 9 enucleorections) were performed. Of all 111 interventions, 63 (56.8%) were on tumors located deep in the liver parenchyma, and 48 (43.2%) were on tumors located superficially. Resections of superficial hemangiomas are 22 (19.8%). Resections of deep hemangiomas were 62 (55.9%). Of all 27 enucleations, 26 (18%) were on superficial hemangiomas. Only one enucleation of a deep single hemangioma was performed. The average operating time for resections was 188,438 minutes, and 169,524 minutes for enucleations. In resections the average blood loss is 180,938 ml, and in enucleations is 145,238 ml. The postoperative stay during resections is 6.59 days on average, and during enucleations it is 5.1 days. There are postoperative complications in 13 (16.2%) resections and 1 (4.8%) enucleations. Surgical complications were 9 (11.2%) in resections and 1 (4.8%) in enucleations.
Discussion: Resection is performed on a deep tumor and enucleation is performed on a superficial tumor. The chance to perform resection in a single deep hemangioma is 56 times higher than to perform enucleation (p <0.001). No statistical difference was found in terms of blood loss and operative time between resection and enucleation in the group we studied. A statistically significant relationship was found between postoperative stay and the type of intervention. In resections, the postoperative stay was longer by an average of 1.5 days (p = 0.018). No statistically significant relationship was found between the choice of resection or enucleation and the complications that occurred, including surgical complications.
Conclusion: The adequate differentiated approach in each individual patient with hepatic hemangioma is the most direct way to his successful treatment. Knowledge of the factors that increase the frequency of postoperative complications determines the choice of surgical procedure.
hepatic hemangioma, anatomical resection, atypical resection, enucleation, enucleoresection