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| Giant cavernous liver hemangiomas: is it the time to change the size categories? |
| Isidoro Di Carlo, Renol Koshy, Saif Al Mudares, Annalisa Ardiri, Gaetano Bertino and Adriana Toro |
Catania, Italy
Author Affiliations: Departments of General Surgery, Hamad General Hospital, Doha, Qatar (Di Carlo I, Koshy R and Al Mudares S); Department of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy (Di Carlo I); Hepatology Unit, Department of Medical and Pediatric Science, University of Catania, Catania, Italy (Ardiri A and Bertino G); Department of Surgery, Patti Hospital, Messina, Italy (Toro A)
Corresponding Author: Isidoro Di Carlo, MD, PhD, FACS, Professor of Surgery, Department of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Cannizzaro Hospital, via Messina 826, 95126 Catania, Italy (Tel: +390957264863; Fax: +390957263020; Email: idicarlo@unict.it) |
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Abstract BACKGROUND: Four different sizes (4, 5, 8 and 10 cm in diameter) can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category “giant” for liver hemangioma.
DATA SOURCES: We reviewed the reports on the categorization of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symptomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups: <5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and ≥15.0 cm in diameter. Inclusion criteria were noted in 34 articles involving 1972 (43.0%) hemangiomas (>4.0 cm).
RESULTS: The patients were divided into the following groups: 154 patients (30.0%) with hemangiomas less than 5.0 cm in diameter (small), 182 (35.5%) between 5.0 cm and 9.9 cm (large), 75 (14.6%) between 10.0 and 14.9 cm (giant), and 102 (19.9%) more than 15.0 cm (enormous). There were 786 (39.9%) asymptomatic patients and 791 (40.1%) symptomatic patients. Indications for surgery related to symptoms were reported in only 75 (3.8%) patients. Operations including 137 non-anatomical resection (12.9%) and 469 enucleation (44.1%) were unclearly related to size and symptoms.
CONCLUSIONS: The term “giant” seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as “giant” are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.
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2016, Vol. 15 
