TY - JOUR
T1 - Proposal of size-based surgical indication criteria for liver hemangioma based on a nationwide survey in Japan
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 - Kinoshita, Hisafumi
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
N1 - Funding Information:
This work is supported in part by Grant-in-Aid for Japan Agency for Medical Research and Development.
Publisher Copyright:
© 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2017/7
Y1 - 2017/7
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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U2 - 10.1002/jhbp.464
DO - 10.1002/jhbp.464
M3 - Article
C2 - 28516570
AN - SCOPUS:85021256756
SN - 1868-6974
VL - 24
SP - 417
EP - 425
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
IS - 7
ER -