Is laparoscopic hepatectomy suitable for giant hepatic hemangioma larger than 10 cm in diameter?

Surgical treatment of giant hepatic hemangioma larger than 10 cm in diameter often requires major laparoscopic liver resection (LLR), which is very difficult and has a high risk of bleeding. There is no consensus as to whether giant hepatic hemangioma is an indication or a contraindication for laparoscopic surgery.

From 2011/09 to 2018/05, 58 patients with giant hepatic hemangioma larger than 10 cm underwent laparoscopic surgery. They were divided into high-difficulty (HD) group and low-difficulty (LD) group according to the operation difficulty score. The perioperative data of the two groups were analyzed and compared.

There were 30 patients in the LD group and 28 in the HD group. No differences were showed in sex, age, ASA grade, tumor size, operation time, conversion rate, intraoperative and post-operative blood transfusion rate, and post-operative complications between the two groups. The amount of bleeding in the HD group was significantly higher than that in the LD group (285.7 ± 224.0 vs 189.6 ± 157.6 ml, p = 0.007). The time of hepatic hilar occlusion in the HD group was longer than that in the LD group (25.4 ± 8.8 vs 20.6 ± 7.3 min, p = 0.001), and the rate of hepatic hilar occlusion in the HD group was also higher than that in the LD group (71.4% vs 33.3%, p = 0.004). The incidence of hospitalization days and discharge time in the LD group were shorter than those in the HD group (6.3 ± 1.6 vs 8.2 ± 1.4 days, p = 0.000; 16.4 ± 5.5 vs 21.9 ± 4.6 h, p = 0.019). There was no significant difference in enzymatic parameters between the two groups after operation.

Although there are great difficulties and risks objectively, laparoscopic treatment of giant hepatic hemangioma is safe and feasible.