Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan

the Japanese Society of Hepato-Biliary-Pancreatic Surgery

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Surgical indications for liver hemangioma remain unclear. Methods: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5–10 cm (n = 164, 32%), Group C 10–15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). Results: Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. Conclusions: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5–10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.

Original languageEnglish
Pages (from-to)417-425
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume24
Issue number7
DOIs
Publication statusPublished - Jul 1 2017

Fingerprint

Hemangioma
Japan
Liver
Hepatectomy
Neoplasms
Liver Failure
Surveys and Questionnaires
Morbidity
Mortality
Incidence

Keywords

  • Kasabach-Merritt syndrome
  • Liver hemangioma
  • Rupture
  • Surgical indication
  • Tumor size

ASJC Scopus subject areas

  • Surgery
  • Hepatology

Cite this

Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan. / the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 24, No. 7, 01.07.2017, p. 417-425.

Research output: Contribution to journalArticle

the Japanese Society of Hepato-Biliary-Pancreatic Surgery. / Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2017 ; Vol. 24, No. 7. pp. 417-425.
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abstract = "Background: Surgical indications for liver hemangioma remain unclear. Methods: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24{\%}), Group B 5–10 cm (n = 164, 32{\%}), Group C 10–15 cm (n = 124, 24{\%}), and Group D >15 cm (n = 100, 20{\%}). Results: Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5{\%}) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7{\%}). Diagnostic accuracy was 98.4{\%} in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0{\%} vs. 0.5{\%}, P = 0.02). Only one operative death was observed (0.2{\%}) in Group D. Conclusions: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5–10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.",
keywords = "Kasabach-Merritt syndrome, Liver hemangioma, Rupture, Surgical indication, Tumor size",
author = "{the Japanese Society of Hepato-Biliary-Pancreatic Surgery} and Yoshihiro Sakamoto and Norihiro Kokudo and Takeyuki Watadani and Junji Shibahara and Masakazu Yamamoto and Hiroki Yamaue and Yoshiaki Tsuchiya and Itaru Endo and Hedio Baba and Naoki Sakurai and Masatoshi Makuuchi and Takahito Yagi and Takahito Yagi and Yoshifumi Beck and Katsuhiko Yanaga and Tadashi Tsukamoto and Michiaki Unno and Tetsushige Mimura and Hideki Ohdan and Toru Mizuguchi and Ysunari Sakuma and Masaru Miyazaki and Masaji Hashimoto and Masato Nagino and Shoji Kubo",
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AU - the Japanese Society of Hepato-Biliary-Pancreatic Surgery

AU - Sakamoto, Yoshihiro

AU - Kokudo, Norihiro

AU - Watadani, Takeyuki

AU - Shibahara, Junji

AU - Yamamoto, Masakazu

AU - Yamaue, Hiroki

AU - Tsuchiya, Yoshiaki

AU - Endo, Itaru

AU - Baba, Hedio

AU - Sakurai, Naoki

AU - Makuuchi, Masatoshi

AU - Yagi, Takahito

AU - Yagi, Takahito

AU - Beck, Yoshifumi

AU - Yanaga, Katsuhiko

AU - Tsukamoto, Tadashi

AU - Unno, Michiaki

AU - Mimura, Tetsushige

AU - Ohdan, Hideki

AU - Mizuguchi, Toru

AU - Sakuma, Ysunari

AU - Miyazaki, Masaru

AU - Hashimoto, Masaji

AU - Nagino, Masato

AU - Kubo, Shoji

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N2 - Background: Surgical indications for liver hemangioma remain unclear. Methods: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5–10 cm (n = 164, 32%), Group C 10–15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). Results: Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. Conclusions: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5–10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.

AB - Background: Surgical indications for liver hemangioma remain unclear. Methods: Of 510 patients undergoing surgical resection for liver hemangioma in 118 Japanese centers between 1998 and 2012, abdominal symptoms, diagnostic accuracy, and surgical outcomes were analyzed to propose size-based surgical indications. Patients were classified into four groups based on tumor size: Group A ≤5 cm (n = 122, 24%), Group B 5–10 cm (n = 164, 32%), Group C 10–15 cm (n = 124, 24%), and Group D >15 cm (n = 100, 20%). Results: Hemangiomas in Group A were most frequently diagnosed as malignant tumors (43.5%) due to the absence of typical imaging findings and with highest incidence of positive HBV (15.7%). Diagnostic accuracy was 98.4% in Groups B to D. Liver failure after hepatectomy was higher in Group D than in Groups A to C (3.0% vs. 0.5%, P = 0.02). Only one operative death was observed (0.2%) in Group D. Conclusions: In patients with ≤5 cm hemangioma, surgical resection can be indicated when a malignant tumor cannot be ruled out. However, surgery for 5–10 cm asymptomatic hemangiomas should be limited. Experienced hepatic surgeons should conduct hepatectomy for tumors >15 cm to avoid serious morbidity or mortality.

KW - Kasabach-Merritt syndrome

KW - Liver hemangioma

KW - Rupture

KW - Surgical indication

KW - Tumor size

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