Giant cavernous liver hemangiomas: effect of operative approach on outcome.

HYPOTHESIS The choice of operative technique for resection of giant cavernous hepatic hemangiomas has an effect on outcome. DESIGN Case series. SETTING Tertiary hepatobiliary surgery-liver transplantation service. PATIENTS AND INTERVENTIONS Fifty-two adult patients who underwent resection of symptomatic hepatic hemangiomas (38 [73%] in the right lobe; average diameter, 10.9 cm) by means of lobectomy or enucleation, with or without Pringle inflow occlusion. MAIN OUTCOME MEASURES Blood transfusion, morbidity, mortality, and length of hospitalization. RESULTS Patient age and sex and the size of hemangiomas were similar for patients who underwent lobectomy and enucleation. Right-lobe lesions were more often treated by enucleation, and inflow occlusion was used more frequently; transfusion requirements and length of hospitalization were similar for both techniques. Complications were more frequent after lobectomy. There were no deaths. In the latter years of the series, enucleation was used in 22 (63%) and inflow occlusion in 24 (69%) of 35 patients. CONCLUSIONS Outcome is related to the operative approach used for resection of giant cavernous liver hemangiomas. Although lobectomy and enucleation are curative, enucleation offers greater preservation of normal hepatic parenchyma and fewer complications and is the preferred technique for suitable lesions.