Korean J Intern Med. 2023;38(6):818-830.

Hepatic hemangioma: proportion and predictor of surgical treatment with emphasis on its growth rate.

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제1저자 신영철, 조은주 · 교신저자 정숙향

PMID 37939665 PMC10636540 DOI 10.3904/kjim.2023.062 IF 2.2 소화기내과

소속 (6)

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS There are limited studies on the management of hepatic hemangiomas (HHs). We investigated the proportion and predictors of surgical resection and analyzed HH growth rates in addition to associated factors.

METHODS A retrospective case-control study of patients treated in 2 centers was conducted. Thirty-six patients who underwent surgical resection were assigned to the case group. Patients who did not undergo surgical treatment were randomly sigselected at a 1:10 ratio and assigned to the control group (n = 360). Baseline characteristics, clinical course and surgical outcomes were analyzed.

RESULTS The proportion of surgically treated HH patients was 0.3% (36 per 11,049). The longest diameter at diagnosis (mean ± standard deviation) was 7.7 ± 5.2 cm in the case group and 2.4 ± 1.8 cm in the control group (p < 0.001). In the multivariate analysis, the presence of more than 2 HHs (odds ratio [OR] 7.64, 95% confidence interval [CI] 1.40-41.72) and a growth rate of more than 4.8%/year (OR 30.73, 95% CI 4.86-194.51) were independently associated with surgical treatment. Symptom development during follow-up was related to HH size > 10 cm (OR 10.50, 95% CI 1.06-103.77, p = 0.04). The subgroup analysis showed substantial growth in 41.3% with an overall mean annual growth rate of 0.14 cm.

CONCLUSION Approximately one in 300 patients with an HH underwent surgical treatment. Multiple HHs and a growth rate of more than 4.8%/year were indications for surgical treatment. Nearly half of the HHs showed growing pattern in our study.

Keywords

Arteriovenous malformationHemangiomaLiverSurgery

Figures

**Figure 1** Flow chart indicating the patient enrollment for the two study aims. CDW, clinical database warehouse.

**Figure 2** Pie chart indicating the growth patterns overall and according to the initial size categories of subgroups. (A) Growth pattern in the overall subgroup (n = 223). (B) Growth pattern in hemangiomas measuring < 5 cm (n = 187). (C) Growth pattern in hemangiomas measuring ≥ 5 cm but < 10 cm (n = 30). (D) Growth pattern in hemangiomas measuring ≥ 10 cm (n = 6). Substantial growth was defined as growth of ≥ 5% compared to the initial longest diameter. Substantial shrinkage was defined as shrinkage of ≥ 5% compared to the initial longest diameter. Stable hemangioma size was defined as ranging between substantial growth and shrinkage.

**Figure 3** Relationship between size at diagnosis or initiation of follow-up and hemangioma growth rate. The correlation analysis between the initial longest diameter of the HH and the annual growth rate showed a weak positive correlation (Spearman’s rank correlation coefficient [rho]: 0.29, p < 0.001). This result suggested that initially large HHs tend to show rapid growth but do not necessarily show rapid growth in all cases. HH, hepatic hemangioma.

그림 출처: PubMed Central 공개 논문 (PMC10636540)

Conflict of interest statement

Conflicts of interest . The authors disclose no conflicts.

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