Surgical management of giant hepatic haemangioma - need for redefining the nomenclature according to the size

Introduction: Haemangiomas are the most common benign tumours of the liver. Most of them are asymptomatic. Giant hepatic haemangioma is defined as of size greater than 5 cm in diameter. The surgical treatment for giant hepatic haemangioma is not very well defined and reported. Here we analysed the treatment outcome of giant hepatic haemangiomas and redefined the nomenclature according to the size, proposing an algorithm for management of all hepatic haemangiomas. Material and methods: Retrospective analyses of 6 giant hepatic haemangiomas more than 10 cm in size treated by a single surgeon were included. The clinical characteristics, diagnosis, management and outcomes were recorded. Review of literature was done for definitions, management strategies and treatment outcome of giant haemangiomas and an algorithm was proposed. Results: Five patients were female and the mean age was 36.6 years (range 32 to 45). Pain of the abdomen was the most common symptom (100%). Ultrasound of the abdomen was the initial diagnostic modality followed by contrast-enhanced computed tomography. The mean size of haemangioma was 17.4 cm (range from 12 cm to 32 cm). Four patients had haemangioma in the left lobeand two in the right lobe of the liver. Formal hepatectomy was done in three patients and enucleation was done in three patients. The mean operating time was 3.66 hours (range from 2.5 hours to 5 hours). The mean blood loss was 840 mL (range from 300 mL to 1500 mL). There was no surgical morbidity or mortality. On follow-up, no haemangioma-related complications are reported. Conclusions: Giant hepatic haemangioma is mostly symptomatic. Hepatectomy and enucleation can be done without significant morbidity and mortality. There is a need for redefining the nomenclature of giant hepatic haemangiomas according to their size.