Materiały źródłowe

• #1 Transarterial embolization for the treatment of complicated liver hemangiomas: A report of two cases and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6166110/

  Hemangioma is the most common benign liver tumor with a frequency of 0.4-7.3% in autopsy series. […] Symptomatic liver hemangiomas are, generally, treated by surgery (hepatic resection or enucleation, open, laparoscopic or robotic). […] Over the past years, transarterial embolization (TAE) has gained ground as an alternative therapeutic strategy for symptomatic hemangiomas, mostly preoperatively, but also as a definite therapy. […] We herein describe two cases of bleeding hemangiomas being successfully treated solely with TAE. […] The management of liver hemangiomas generally consists of counseling and periodic follow-up. Treatment is reserved for special cases and this should be decided based on the size and location of the tumor. […] In the recent years, TAE has been increasingly used as a preoperative treatment method for bleeding giant hemangiomas in order to achieve hemodynamic stability of the patient, before definite surgical treatment.

• #2 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. In a prospective study, an increase in the hemangioma size was noted in only 1 of 47 patients who were rescanned 1-6 years after the initial diagnosis. In addition, malignant transformation has not been reported in hepatic hemangiomas. For these reasons, most hepatic hemangiomas may be left safely alone. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, it remains uncertain whether follow-up radiologic studies are warranted to reassess the size of the tumor. The American College of Gastroenterology (ACG) recommends against the performance of routine follow-up imaging studies for patients diagnosed with hepatic hemangioma, except in the setting of chronic hepatitis B.

• #3 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  If your liver hemangioma is small and doesn’t cause any signs or symptoms, you won’t need treatment. In most cases a liver hemangioma will never grow and will never cause problems. Your doctor may schedule follow-up exams to check your liver hemangioma periodically for growth if the hemangioma is large. […] Liver hemangioma treatment depends on the location and size of the hemangioma, whether you have more than one hemangioma, your overall health, and your preferences. […] Treatment options may include: […] Surgery to remove the liver hemangioma. If the hemangioma can be easily separated from the liver, your doctor may recommend surgery to remove the mass. […] Surgery to remove part of the liver, including the hemangioma. In some cases, surgeons may need to remove a portion of your liver along with the hemangioma.

• #4 Liver Hemangioma – Symptoms, Causes and TreatmentLPC

  https://liverandpancreasclinic.com/blog/2018/03/23/liver-hemangioma/

  This is a patient information booklet providing specific practical information about hepatic hemangioma in brief. Its aim is to provide the patient his or her family with useful information on this particular liver problem, the procedures and tests you may need to undergo, treatment approaches, risks involved, duration, expenses and helpful advice on coping successfully with the problem. […] Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. In addition, malignant transformation has not been reported in hepatic hemangiomas. Even large hemangiomas have very little risk of complications. For these reasons, most asymptomatic hepatic hemangiomas are left safely alone. […] Hepatic hemangiomas warrant therapy only if they are causing significant symptoms and the cause of pain is proved to be hemangioma beyond doubt. Therefore all tests must be performed to rule out other causes for pain like peptic ulcer disease, colitis, gastroduodenitis, gallstones irritable bowel syndrome.

• #5 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  If your liver hemangioma is small and doesn’t cause any signs or symptoms, you won’t need treatment. In most cases a liver hemangioma will never grow and will never cause problems. Your doctor may schedule follow-up exams to check your liver hemangioma periodically for growth if the hemangioma is large. […] Liver hemangioma treatment depends on the location and size of the hemangioma, whether you have more than one hemangioma, your overall health, and your preferences. […] Treatment options may include: […] Surgery to remove the liver hemangioma. If the hemangioma can be easily separated from the liver, your doctor may recommend surgery to remove the mass. […] Surgery to remove part of the liver, including the hemangioma. In some cases, surgeons may need to remove a portion of your liver along with the hemangioma.

• #6 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. […] HH treatment should strictly follow the treatment indications and observe the principle of delivering the most significant therapeutic effect with the least trauma to patients. The treatment indications are as follows: (1) The appearance of associated clinical symptoms or serious complications, such as abdominal pain, abdominal distension, dyspepsia, ruptured bleeding, and Kasabach-Merritt syndrome. (2) Progressive enlargement of hepatic hemangioma: The current view is that an annual growth rate 2 cm in diameter represents rapid growth. If the initially detected tumor is already large, there may be a risk of complications with various symptoms, and the treatment is recommended as appropriate. (3) HH cannot be definitively diagnosed, and it is generally difficult to diagnose hemangioma by combining one or more imaging modalities. However, atypical tumors may present in some imaging modalities, especially in patients with viral hepatitis, cirrhosis, liver cancer, or other malignancies that may be treated effectively. (4) Severe anxiety and other psychiatric symptoms caused by hepatic hemangioma, including in patients with HH receiving treatment, as well as patients requiring treatment because of anxiety or other adverse psychological conditions due to fear of tumor growth, malignant transformation, or rupture.

• #7 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. […] HH treatment should strictly follow the treatment indications and observe the principle of delivering the most significant therapeutic effect with the least trauma to patients. The treatment indications are as follows: (1) The appearance of associated clinical symptoms or serious complications, such as abdominal pain, abdominal distension, dyspepsia, ruptured bleeding, and Kasabach-Merritt syndrome. (2) Progressive enlargement of hepatic hemangioma: The current view is that an annual growth rate 2 cm in diameter represents rapid growth. If the initially detected tumor is already large, there may be a risk of complications with various symptoms, and the treatment is recommended as appropriate. (3) HH cannot be definitively diagnosed, and it is generally difficult to diagnose hemangioma by combining one or more imaging modalities. However, atypical tumors may present in some imaging modalities, especially in patients with viral hepatitis, cirrhosis, liver cancer, or other malignancies that may be treated effectively. (4) Severe anxiety and other psychiatric symptoms caused by hepatic hemangioma, including in patients with HH receiving treatment, as well as patients requiring treatment because of anxiety or other adverse psychological conditions due to fear of tumor growth, malignant transformation, or rupture.

• #8 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangiomas account for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. […] The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.

• #9 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. […] Liver hemangiomas, if indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.

• #10 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #11 Liver Hemangioma | Liver Cancer | UPMC Center for Liver Care

  https://www.upmc.com/services/digestive-disorders-center/services/liver-diseases/conditions/liver-cancer/liver-hemangioma

  Most liver hemangiomas don’t need any treatment. If the mass is larger than 5 centimeters, your doctor may schedule follow-up exams once or twice a year. […] They may treat liver hemangiomas that are causing symptoms. […] Your doctor may recommend trans-arterial embolization to prevent blood from getting to the mass. During this treatment, doctors inject medicine into the hepatic artery to block blood flow. This helps reduce the tumor’s size and stop it from getting bigger. […] If your mass is large, surgeons may want to remove it. If they can’t separate the hemangioma easily, they may remove part of your liver as well. […] Liver transplant for even large hemangiomas (more than 5 centimeters) is rare. […] Doctors may consider transplant only if: The mass puts pressure on other organs or causes pain, but surgeons aren’t able to separate it from healthy liver tissue. […] The hemangioma is in danger of rupturing. […] There are many masses throughout the liver, affecting the organ’s function.

• #12 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  Liver hemangiomas are commonly the most frequent benign lesion of the liver. A liver hemangioma is qualified giant when it has a size larger than 5cm. Asymptomatic and non-complicated giant liver are managed conservatively by observation. However, lesion with incapacitating symptoms or complications is managed surgically. Surgery remains the most effective and radical therapeutic modality to treat liver hemangioma. Thus both enucleation and liver resection can be performed to remove the lesion. However recent studies demonstrated that enucleation was a safer, quicker surgical procedure and associated with lower complication and less blood loss. […] Severe incapacitating symptomatology or complications occurred during observation are justifiable of surgical management. Surgery is the most effective therapeutic modality to treat liver hemangioma. A hemangioma can be removed by enucleation or liver resection however, most authors advocated enucleation procedure.

• #13

  https://journals.lww.com/md-journal/fulltext/2015/08040/surgical_treatment_of_giant_liver_hemangioma.29.aspx

  The ideal surgical treatment of giant liver hemangioma is still controversial. This study aims to compare the outcomes of enucleation with those of resection for liver hemangioma larger than 10 cm in different locations of the liver and establish the preoperative predictors of increased intraoperative blood loss. […] Both enucleation and liver resection are safe and effective surgical treatments for liver hemangiomas larger than 10 cm. The risk of intraoperative blood loss is related to adjacency to major vascular structures and the location of hemangioma. […] Indications for surgery include the presence of progressive abdominal symptoms, spontaneous or traumatic rupture, rapidly enlarging lesions, Kasabach-Merritt syndrome and unclear diagnosis. Four types of surgical procedures including liver resection, enucleation, hepatic artery ligation, and liver transplantation have been reported as treatments for liver hemangiomas. Resection and enucleation remain the most commonly used surgical methods.

• #14 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  The indications of surgery for giant liver hemangioma is well defined and symptomatic or complicated lesions are the most conditions requiring surgical management. Furthermore surgery remains the effective therapeutic method to treat liver hemangioma. Surgery includes liver resection, enucleation and transplantation. […] When surgery is indicated, hemangioma can be removed by both liver resection and enucleation procedures. The choice between liver resection and enucleation depends mainly on location, number and size tumor, complications, preference and technical skills of surgeon. Enucleation is more preferred in peripheral and right-sided located hemangioma. […] According to advances made in liver surgery, enucleation meets the requirement of precise liver surgery which is precision, minimal invasiveness, and effectiveness.

• #15 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  The indications of surgery for giant liver hemangioma is well defined and symptomatic or complicated lesions are the most conditions requiring surgical management. Furthermore surgery remains the effective therapeutic method to treat liver hemangioma. Surgery includes liver resection, enucleation and transplantation. […] When surgery is indicated, hemangioma can be removed by both liver resection and enucleation procedures. The choice between liver resection and enucleation depends mainly on location, number and size tumor, complications, preference and technical skills of surgeon. Enucleation is more preferred in peripheral and right-sided located hemangioma. […] According to advances made in liver surgery, enucleation meets the requirement of precise liver surgery which is precision, minimal invasiveness, and effectiveness.

• #16

  https://journals.lww.com/md-journal/fulltext/2015/08040/surgical_treatment_of_giant_liver_hemangioma.29.aspx

  The ideal surgical treatment of giant liver hemangioma is still controversial. This study aims to compare the outcomes of enucleation with those of resection for liver hemangioma larger than 10 cm in different locations of the liver and establish the preoperative predictors of increased intraoperative blood loss. […] Both enucleation and liver resection are safe and effective surgical treatments for liver hemangiomas larger than 10 cm. The risk of intraoperative blood loss is related to adjacency to major vascular structures and the location of hemangioma. […] Indications for surgery include the presence of progressive abdominal symptoms, spontaneous or traumatic rupture, rapidly enlarging lesions, Kasabach-Merritt syndrome and unclear diagnosis. Four types of surgical procedures including liver resection, enucleation, hepatic artery ligation, and liver transplantation have been reported as treatments for liver hemangiomas. Resection and enucleation remain the most commonly used surgical methods.

• #17 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. […] In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. […] Surgery continues to be the most common treatment for HH. Surgical management includes liver resection, enucleation, hepatic artery ligation and liver transplantation. […] Enucleation is associated with lower morbidity, shorter operation time, less blood loss and fewer complications. […] Transcatheter arterial embolization (TAE) is used to control acute bleeding or shrink HH prior to surgery with metallic coils, gelform particles, polyvinyl alcohol and liquid agents such as N-butyl-2-cyanoacrylate, bleomycin-lipiodol.

• #18 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  When surgery is indicated, giant liver hemangiomas can be safely removed by either enucleation or liver anatomic resection. Compared to resection, enucleation is associated with lower morbidity and less blood loss. Hence, this surgical procedure is advocated by most surgeons to treat liver hemangioma. Transarterial embolization (TAE) and radiofrequency ablation are to be considered before surgery in an extremely large lesion to reduce the risk of bleeding and complications.

• #19 Outcomes of surgery for giant hepatic hemangioma | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01185-4

  The surgical indications for liver hemangioma remain unclear. […] The main indication for surgery is giant (10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. […] Treatments for hepatic hemangioma include radiofrequency ablation (RFA), monoclonal antibody therapy, radiation therapy (RT), trans-arterial embolization (TAE), interferon therapy, liver transplantation, and surgical procedures (enucleation and resection). […] Hepatic resection has historically been the most common therapy for hepatic hemangioma. However, enucleation is now used more frequently and is favored by surgeons due to its safety and the reduction of blood loss and complication rates. […] Laparoscopic liver resection is used widely for hepatic hemangioma because it decreases postoperative complications, enables more rapid patient discharge, and supports better postoperative cosmetic satisfaction.

• #20 Outcomes of surgery for giant hepatic hemangioma | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01185-4

  Our data revealed no difference in the operative time, estimated blood loss, and major morbidity and mortality between laparoscopic and open liver resection for hepatic hemangioma, with a significant reduction in the length of stay associated with laparoscopic liver resection. Although our study was retrospective, we recommend laparoscopic hepatectomy as a treatment option for hepatic hemangioma. […] Hepatectomy should be performed by experienced hepatic surgeons.

• #21 The Two-Step Treatment for Giant Hepatic Hemangiomas

  https://www.mdpi.com/2077-0383/10/19/4381

  The aim of the present study is to analyze the feasibility and the impact of a two-step approach in the treatment of giant hemangiomas (GH) i.e., exceeding 10 cm in maximum diameter, consisting of transarterial embolization (TAE) followed by laparoscopic liver resection (LLR). […] Successful microparticle embolization of the GH-feeding arteries was performed in all patients in group A. […] Our data suggest that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH >10 cm. […] The aim of the present study is to systematically analyze the clinical efficacy and safety of a two-step approach for the treatment of GHs exceeding 10 cm, consisting of preoperative TAE followed by LLR, and to evaluate its outcomes in comparison to upfront stand-alone LLR. […] In conclusion, despite LLR having only been initially recommended for lesions < 5 cm, our results suggested that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH > 10 cm.

• #22 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  Procedures to stop blood flow to the hemangioma. Without a blood supply, the hemangioma may stop growing or shrink. Two ways to stop the blood flow are tying off the main artery (hepatic artery ligation) or injecting medication into the artery to block it (arterial embolization). Healthy liver tissue is unharmed because it can draw blood from other nearby vessels. […] Liver transplant surgery. In the unlikely event that you have a large hemangioma or multiple hemangiomas that can’t be treated by other means, your doctor may recommend surgery to remove your liver and replace it with a liver from a donor. […] Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays, to damage the cells of the hemangioma. This treatment is rarely used because of the availability of safer and more-effective treatments.

• #23 Liver Hemangioma | Liver Cancer | UPMC Center for Liver Care

  https://www.upmc.com/services/digestive-disorders-center/services/liver-diseases/conditions/liver-cancer/liver-hemangioma

  Most liver hemangiomas don’t need any treatment. If the mass is larger than 5 centimeters, your doctor may schedule follow-up exams once or twice a year. […] They may treat liver hemangiomas that are causing symptoms. […] Your doctor may recommend trans-arterial embolization to prevent blood from getting to the mass. During this treatment, doctors inject medicine into the hepatic artery to block blood flow. This helps reduce the tumor’s size and stop it from getting bigger. […] If your mass is large, surgeons may want to remove it. If they can’t separate the hemangioma easily, they may remove part of your liver as well. […] Liver transplant for even large hemangiomas (more than 5 centimeters) is rare. […] Doctors may consider transplant only if: The mass puts pressure on other organs or causes pain, but surgeons aren’t able to separate it from healthy liver tissue. […] The hemangioma is in danger of rupturing. […] There are many masses throughout the liver, affecting the organ’s function.

• #24 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Radiofrequency ablation (RFA) can be used percutaneously, laparoscopically or by open surgery. RFA induces a thermal damage to endothelial vascular structures and promotes thrombosis. […] The established indications for RFA in this population are maximum diameter of HH 5 cm, tumor gaining enlargement 1 cm within 2 years, persistent HH related abdominal pain with exclusion of other GI diseases. […] Liver transplantation for benign solid tumors is not considered a first line treatment due to morbidity and organ shortage.

• #25 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Surgical and interventional therapies for HHs have the highest dominance; however, both have advantages and disadvantages. Although surgery is considered the most appropriate option for some HHs, treating multiple and/or massive HHs remains a major clinical challenge. Due to recent advances in minimally invasive interventional techniques, surgery is no longer the preferred treatment for multiple or extensive lesions. Interventional treatment, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy, has gradually developed as an alternative approach to surgical resection for treating hepatic tumors. […] Transcatheter arterial embolization has become the main treatment method for HH because of its advantages of being minimally invasive, less painful, reproducible, and highly efficient.

• #26 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Surgical and interventional therapies for HHs have the highest dominance; however, both have advantages and disadvantages. Although surgery is considered the most appropriate option for some HHs, treating multiple and/or massive HHs remains a major clinical challenge. Due to recent advances in minimally invasive interventional techniques, surgery is no longer the preferred treatment for multiple or extensive lesions. Interventional treatment, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy, has gradually developed as an alternative approach to surgical resection for treating hepatic tumors. […] Transcatheter arterial embolization has become the main treatment method for HH because of its advantages of being minimally invasive, less painful, reproducible, and highly efficient.

• #27 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Surgical and interventional therapies for HHs have the highest dominance; however, both have advantages and disadvantages. Although surgery is considered the most appropriate option for some HHs, treating multiple and/or massive HHs remains a major clinical challenge. Due to recent advances in minimally invasive interventional techniques, surgery is no longer the preferred treatment for multiple or extensive lesions. Interventional treatment, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy, has gradually developed as an alternative approach to surgical resection for treating hepatic tumors. […] Transcatheter arterial embolization has become the main treatment method for HH because of its advantages of being minimally invasive, less painful, reproducible, and highly efficient.

• #28 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  Procedures to stop blood flow to the hemangioma. Without a blood supply, the hemangioma may stop growing or shrink. Two ways to stop the blood flow are tying off the main artery (hepatic artery ligation) or injecting medication into the artery to block it (arterial embolization). Healthy liver tissue is unharmed because it can draw blood from other nearby vessels. […] Liver transplant surgery. In the unlikely event that you have a large hemangioma or multiple hemangiomas that can’t be treated by other means, your doctor may recommend surgery to remove your liver and replace it with a liver from a donor. […] Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays, to damage the cells of the hemangioma. This treatment is rarely used because of the availability of safer and more-effective treatments.

• #29 Transarterial embolization for the treatment of complicated liver hemangiomas: A report of two cases and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6166110/

  Hemangioma is the most common benign liver tumor with a frequency of 0.4-7.3% in autopsy series. […] Symptomatic liver hemangiomas are, generally, treated by surgery (hepatic resection or enucleation, open, laparoscopic or robotic). […] Over the past years, transarterial embolization (TAE) has gained ground as an alternative therapeutic strategy for symptomatic hemangiomas, mostly preoperatively, but also as a definite therapy. […] We herein describe two cases of bleeding hemangiomas being successfully treated solely with TAE. […] The management of liver hemangiomas generally consists of counseling and periodic follow-up. Treatment is reserved for special cases and this should be decided based on the size and location of the tumor. […] In the recent years, TAE has been increasingly used as a preoperative treatment method for bleeding giant hemangiomas in order to achieve hemodynamic stability of the patient, before definite surgical treatment.

• #30 Liver Hemangioma: What it Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17784-liver-hemangioma

  Do liver hemangiomas need to be removed? Not unless they cause you problems. If your hemangioma appears to be growing, your healthcare provider may suggest interventions to stop it before it becomes a problem. They can cut off its blood supply by blocking or tying off the hepatic artery (arterial embolization). This can slow or even reverse its growth. If it continues growing, or if it causes any symptoms or complications, they can remove it in surgery. […] How are liver hemangiomas usually treated? In most cases, your healthcare provider will simply keep your tumor under observation. They may want to take an imaging scan once or twice a year to keep track of any changes. Most hemangiomas wont ever change or grow. If they do, it’s usually slow about 2mm a year. […] A note from Cleveland Clinic: Nobody likes to find out they have a tumor, but liver hemangiomas are common and benign. If you have one, it will probably never bother you. It wont turn into another type of tumor, as some benign lesions can. It usually wont grow or change at all. You can feel at ease leaving it alone and letting your healthcare provider keep an eye on it. If you have a large or symptomatic liver hemangioma, your healthcare provider can offer ways of treating it. Surgery, if necessary, will remove the tumor.

• #31 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. […] In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. […] Surgery continues to be the most common treatment for HH. Surgical management includes liver resection, enucleation, hepatic artery ligation and liver transplantation. […] Enucleation is associated with lower morbidity, shorter operation time, less blood loss and fewer complications. […] Transcatheter arterial embolization (TAE) is used to control acute bleeding or shrink HH prior to surgery with metallic coils, gelform particles, polyvinyl alcohol and liquid agents such as N-butyl-2-cyanoacrylate, bleomycin-lipiodol.

• #32 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  Procedures to stop blood flow to the hemangioma. Without a blood supply, the hemangioma may stop growing or shrink. Two ways to stop the blood flow are tying off the main artery (hepatic artery ligation) or injecting medication into the artery to block it (arterial embolization). Healthy liver tissue is unharmed because it can draw blood from other nearby vessels. […] Liver transplant surgery. In the unlikely event that you have a large hemangioma or multiple hemangiomas that can’t be treated by other means, your doctor may recommend surgery to remove your liver and replace it with a liver from a donor. […] Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays, to damage the cells of the hemangioma. This treatment is rarely used because of the availability of safer and more-effective treatments.

• #33 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Most hemangioma surgeries are performed using an open approach, but laparoscopic surgery can be performed in some cases. […] The management of a large (ie, 10 cm) hepatic hemangioma is controversial. Certainly, large symptomatic hemangiomas should undergo treatment. However, the management of a large asymptomatic lesion is not as clear-cut. […] On rare occasions, liver transplantation has been offered to symptomatic patients with large or diffuse lesions. […] Less commonly used modalities for treating symptomatic hepatic hemangiomas include transarterial embolization of large feeding vessels, radiofrequency ablation, hepatic irradiation, and radiofrequency ablation. […] Transarterial embolization has been employed in cases in which surgical resection was not feasible on account of the massive or diffuse nature of the lesion, the tumors proximity to vascular structures, or the patient’s comorbidities.

• #34 Transarterial embolization for the treatment of complicated liver hemangiomas: A report of two cases and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6166110/

  However, TAE alone could be used as a treatment method for bleeding hemangiomas without follow-up surgical intervention. […] The successful use of TAE before surgery of a ruptured hemangioma was first reported by Yamamoto, et al in 1991. […] According to Srinivasa, et al. TAE is a successful hemostatic method in almost 80% of cases. […] In conclusion, TAE is an effective minimal invasive treatment modality for complicated liver hemangiomas. This treatment approach is ideal for patients with high surgical risk due to its low complication rate. TAE could be used as a primary treatment for giant hemangiomas, standing as a valid alternative option to surgery in selected cases.

• #35 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Ablation treatment of hepatic hemangioma has been used throughout the 21st century. It is a promising treatment approach for symptomatic giant hepatic hemangioma when surgery is not feasible or is declined by the patient. […] Percutaneous sclerotherapy involves percutaneous puncture of the lesion and injection of drugs under the guidance of imaging equipment. […] As a benign lesion with slow growth, no malignant tendency, and an extremely low incidence of serious complications, HH generally does not require treatment. However, provided it meets the treatment indications, physicians should pay further attention to the relationship between the type of blood supply of an HH tumor and its prognosis when choosing an interventional treatment.

• #36 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Radiofrequency ablation (RFA) can be used percutaneously, laparoscopically or by open surgery. RFA induces a thermal damage to endothelial vascular structures and promotes thrombosis. […] The established indications for RFA in this population are maximum diameter of HH 5 cm, tumor gaining enlargement 1 cm within 2 years, persistent HH related abdominal pain with exclusion of other GI diseases. […] Liver transplantation for benign solid tumors is not considered a first line treatment due to morbidity and organ shortage.

• #37 Liver Hemangioma Treatment Without Surgery – Prof. Dr. Özgür Kılıçkesmez

  https://ozgurkilickesmez.com/en/liver-hemangioma-treatment-without-surgery/

  Transarterial embolization (TAE) is preferred for its minimal invasiveness. It targets the tumors arterial supply using chemotherapeutic agents and lipiodol, selectively occluding feeding vessels. The hemangioma shrinks and regresses over time. […] Radiofrequency Ablation (RFA) uses high-frequency currents via electrodes to thermally destroy tumor tissue. Microwave Ablation (MWA) employs electromagnetic waves to rapidly heat and necrotize tumor cells, especially useful in high-bleeding-risk areas. […] Percutaneous methods are effective for small, superficial hemangiomas, offering faster recovery and shorter hospital stays. […] Response to interventional therapies varies by hemangioma vascularity. Highly vascular lesions respond well to embolization and ablation with lower complication rates, while poorly vascularized lesions may show less effect. […] Liver hemangiomas are benign lesions with limited need for treatment, but the correct interventional approach is critical when indicated. Options vary by blood supply: hepatic artery embolization for lesions fed by the hepatic artery, and combined therapies may include RFA for enhanced efficacy.

• #38 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Radiofrequency ablation (RFA) can be used percutaneously, laparoscopically or by open surgery. RFA induces a thermal damage to endothelial vascular structures and promotes thrombosis. […] The established indications for RFA in this population are maximum diameter of HH 5 cm, tumor gaining enlargement 1 cm within 2 years, persistent HH related abdominal pain with exclusion of other GI diseases. […] Liver transplantation for benign solid tumors is not considered a first line treatment due to morbidity and organ shortage.

• #39 Interventional treatments for hepatic hemangioma: A state-of-the-art review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8947984/

  Ablation treatment of hepatic hemangioma has been used throughout the 21st century. It is a promising treatment approach for symptomatic giant hepatic hemangioma when surgery is not feasible or is declined by the patient. […] Percutaneous sclerotherapy involves percutaneous puncture of the lesion and injection of drugs under the guidance of imaging equipment. […] As a benign lesion with slow growth, no malignant tendency, and an extremely low incidence of serious complications, HH generally does not require treatment. However, provided it meets the treatment indications, physicians should pay further attention to the relationship between the type of blood supply of an HH tumor and its prognosis when choosing an interventional treatment.

• #40 【Liver hemangioma】➤ treatment and examination in clinics abroad ⚕️ MedTour

  https://medtour.help/clinics/i-liver-hemangioma/

  So-called vascular embolization, in which the blood vessels feeding the hemangioma are blocked, can slow or reverse its growth. […] Sclerosing is widely used. This method involves injecting a substance into the tumor cavity that glues its walls together and prevents the tumor from forming again. […] If this method is ineffective, surgical intervention is used: segmental liver resection; liver lobe removal. […] The choice of method of surgical treatment of hepatic hemangioma in men and women depends on the rate of its growth, severity of symptoms, presence or absence of complications. […] Direct indications for surgery are: tumor diameter more than 5 cm; increase in tumor size by 50% or more over a year; rupture of the tumor; signs of compression of surrounding tissues; suspected malignant nature of the tumor.

• #41 Comparative Study of TACE with Bleomycin-Lipiodol Emulsion and Percutaneous Local Bleomycin Injection in the Treatment of Giant Hepatic Hemangioma

  https://www.sgo-iasgo.com/article/comparative-study-of-tace-with-bleomycin-lipiodol-emulsion-and-percutaneous-local-bleomycin-injection-in-the-treatment-of-giant-hepatic-hemangioma

  Percutaneous sclerotherapy (PS) has been studied for treating hepatic hemangioma. […] In a preliminary study, patients with giant liver hemangioma received percutaneous sclero-therapy with a mixture of bleomycin and ethiodized oil. […] Both TACE and PLIB are effective in reducing the size of giant hepatic hemangiomas, with initial results favoring PLIB for greater volume reduction. […] The primary outcome of this study is to compare the efficacy of trans-catheter arterial bleomycin chemo-embolization and ultrasound and fluoroscopy-guided transhepatic bleomycin sclerotherapy in terms of reducing the size of giant hepatic hemangiomas. […] The findings in this research indicate that both TACE and PLIB are effective in reducing size of hepatic hemangiomas. […] Initial findings suggest that PLIB may yield a more significant absolute volume reduction compared to TACE.

• #42 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #43 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #44 Hepatic hemangiomas: Spectacular response to treatment with propranolol | Anales de Pediatría

  https://www.analesdepediatria.org/en-hepatic-hemangiomas-spectacular-response-treatment-articulo-S234128791500215X

  Hepatic haemangioma (HH) is the most frequent benign liver tumour in infancy, with a preponderance of female infants. Traditionally, corticosteroids have been used as the first-line treatment of symptomatic HHs, alone or in combination with vincristine (VCR), which started to be used as an alternative to interferon, due to the latter’s side effects, and cyclophosphamide. […] Since 2008, propranolol has been used successfully for the treatment of cutaneous IHs. It acts by stopping the growth of the lesion during the proliferative phase and inducing a rapid involution, effects that have not been observed with other therapies. Its efficacy and safety in the treatment of IHs has been demonstrated by an international randomised controlled trial that established a treatment dose of 3mg/kg/day.

• #45 Hepatic hemangiomas: Spectacular response to treatment with propranolol | Anales de Pediatría

  https://www.analesdepediatria.org/en-hepatic-hemangiomas-spectacular-response-treatment-articulo-S234128791500215X

  Hepatic haemangioma (HH) is the most frequent benign liver tumour in infancy, with a preponderance of female infants. Traditionally, corticosteroids have been used as the first-line treatment of symptomatic HHs, alone or in combination with vincristine (VCR), which started to be used as an alternative to interferon, due to the latter’s side effects, and cyclophosphamide. […] Since 2008, propranolol has been used successfully for the treatment of cutaneous IHs. It acts by stopping the growth of the lesion during the proliferative phase and inducing a rapid involution, effects that have not been observed with other therapies. Its efficacy and safety in the treatment of IHs has been demonstrated by an international randomised controlled trial that established a treatment dose of 3mg/kg/day.

• #46 Hepatic hemangiomas: Spectacular response to treatment with propranolol | Anales de Pediatría

  https://www.analesdepediatria.org/en-hepatic-hemangiomas-spectacular-response-treatment-articulo-S234128791500215X

  Hepatic haemangioma (HH) is the most frequent benign liver tumour in infancy, with a preponderance of female infants. Traditionally, corticosteroids have been used as the first-line treatment of symptomatic HHs, alone or in combination with vincristine (VCR), which started to be used as an alternative to interferon, due to the latter’s side effects, and cyclophosphamide. […] Since 2008, propranolol has been used successfully for the treatment of cutaneous IHs. It acts by stopping the growth of the lesion during the proliferative phase and inducing a rapid involution, effects that have not been observed with other therapies. Its efficacy and safety in the treatment of IHs has been demonstrated by an international randomised controlled trial that established a treatment dose of 3mg/kg/day.

• #47 Hepatic hemangiomas: Spectacular response to treatment with propranolol | Anales de Pediatría

  https://www.analesdepediatria.org/en-hepatic-hemangiomas-spectacular-response-treatment-articulo-S234128791500215X

  Hepatic haemangioma (HH) is the most frequent benign liver tumour in infancy, with a preponderance of female infants. Traditionally, corticosteroids have been used as the first-line treatment of symptomatic HHs, alone or in combination with vincristine (VCR), which started to be used as an alternative to interferon, due to the latter’s side effects, and cyclophosphamide. […] Since 2008, propranolol has been used successfully for the treatment of cutaneous IHs. It acts by stopping the growth of the lesion during the proliferative phase and inducing a rapid involution, effects that have not been observed with other therapies. Its efficacy and safety in the treatment of IHs has been demonstrated by an international randomised controlled trial that established a treatment dose of 3mg/kg/day.

• #48 Hepatic hemangiomas: Spectacular response to treatment with propranolol | Anales de Pediatría

  https://www.analesdepediatria.org/en-hepatic-hemangiomas-spectacular-response-treatment-articulo-S234128791500215X

  Hepatic haemangioma (HH) is the most frequent benign liver tumour in infancy, with a preponderance of female infants. Traditionally, corticosteroids have been used as the first-line treatment of symptomatic HHs, alone or in combination with vincristine (VCR), which started to be used as an alternative to interferon, due to the latter’s side effects, and cyclophosphamide. […] Since 2008, propranolol has been used successfully for the treatment of cutaneous IHs. It acts by stopping the growth of the lesion during the proliferative phase and inducing a rapid involution, effects that have not been observed with other therapies. Its efficacy and safety in the treatment of IHs has been demonstrated by an international randomised controlled trial that established a treatment dose of 3mg/kg/day.

• #49

  https://journals.lww.com/md-journal/fulltext/2019/01250/efficacy_of_infantile_hepatic_hemangioma_with.15.aspx

  In a meta-analysis of 324 patients with infantile hemangiomas and 248 controls, propranolol was superior to other treatments in higher efficacy in tumor regression, lower risk of side effects and faster clinical improvement, sometimes as early as 24 hours, which may be evident in the majority of patients within the first week of treatment. […] The issues of optimal dosage and treatment duration of propranolol for infantile hemangiomas remain open. […] Though the propranolol therapy protocol for IHs is still under developing, the current report strengthens the recommendation to use propranolol as the first-line treatment agent for the disease entity.

• #50

  https://journals.lww.com/md-journal/fulltext/2019/01250/efficacy_of_infantile_hepatic_hemangioma_with.15.aspx

  Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. […] Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription. […] Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas. […] Pharmacological therapy has been known as a primary therapy for infantile hemangiomas and propranolol is the first-line agent.

• #51 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  Procedures to stop blood flow to the hemangioma. Without a blood supply, the hemangioma may stop growing or shrink. Two ways to stop the blood flow are tying off the main artery (hepatic artery ligation) or injecting medication into the artery to block it (arterial embolization). Healthy liver tissue is unharmed because it can draw blood from other nearby vessels. […] Liver transplant surgery. In the unlikely event that you have a large hemangioma or multiple hemangiomas that can’t be treated by other means, your doctor may recommend surgery to remove your liver and replace it with a liver from a donor. […] Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays, to damage the cells of the hemangioma. This treatment is rarely used because of the availability of safer and more-effective treatments.

• #52 Liver hemangioma | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/liver-hemangioma

  Procedures to stop blood flow to the hemangioma. Without a blood supply, the hemangioma may stop growing or shrink. Two ways to stop the blood flow are tying off the main artery (hepatic artery ligation) or injecting medication into the artery to block it (arterial embolization). Healthy liver tissue is unharmed because it can draw blood from other nearby vessels. […] Liver transplant surgery. In the unlikely event that you have a large hemangioma or multiple hemangiomas that can’t be treated by other means, your doctor may recommend surgery to remove your liver and replace it with a liver from a donor. […] Radiation therapy. Radiation therapy uses powerful energy beams, such as X-rays, to damage the cells of the hemangioma. This treatment is rarely used because of the availability of safer and more-effective treatments.

• #53

  https://healthmatch.io/liver-disease/hemangioma-liver

  In extremely rare cases where patients have very large hemangiomas or tumors that extend to both sides of the liver, transplantation may be required. This is usually only the case if complications are severe or resection is not possible. […] Radiation therapy takes place over a few weeks and involves using radiation beams to target the hemangioma and cause the tumor to shrink. It is a relatively uncommonly used treatment. […] Most liver hemangiomas do not require treatment, but when they do, options include restricting blood flow, surgical removal, and radiotherapy.

• #54

  https://healthmatch.io/liver-disease/hemangioma-liver

  In extremely rare cases where patients have very large hemangiomas or tumors that extend to both sides of the liver, transplantation may be required. This is usually only the case if complications are severe or resection is not possible. […] Radiation therapy takes place over a few weeks and involves using radiation beams to target the hemangioma and cause the tumor to shrink. It is a relatively uncommonly used treatment. […] Most liver hemangiomas do not require treatment, but when they do, options include restricting blood flow, surgical removal, and radiotherapy.

• #55 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. In a prospective study, an increase in the hemangioma size was noted in only 1 of 47 patients who were rescanned 1-6 years after the initial diagnosis. In addition, malignant transformation has not been reported in hepatic hemangiomas. For these reasons, most hepatic hemangiomas may be left safely alone. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, it remains uncertain whether follow-up radiologic studies are warranted to reassess the size of the tumor. The American College of Gastroenterology (ACG) recommends against the performance of routine follow-up imaging studies for patients diagnosed with hepatic hemangioma, except in the setting of chronic hepatitis B.

• #56 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Most hepatic hemangiomas are small and asymptomatic at the time of diagnosis, and they are likely to remain that way. In a prospective study, an increase in the hemangioma size was noted in only 1 of 47 patients who were rescanned 1-6 years after the initial diagnosis. In addition, malignant transformation has not been reported in hepatic hemangiomas. For these reasons, most hepatic hemangiomas may be left safely alone. […] Once the diagnosis of hepatic hemangioma is confirmed by radiologic studies, it remains uncertain whether follow-up radiologic studies are warranted to reassess the size of the tumor. The American College of Gastroenterology (ACG) recommends against the performance of routine follow-up imaging studies for patients diagnosed with hepatic hemangioma, except in the setting of chronic hepatitis B.

• #57 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #58 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #59 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #60 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Patients with new onset of abdominal pain deserve a follow-up imaging study. There is disagreement as to whether the patients who undergo treatment with estrogens or women who become pregnant need surveillance; indeed, a number of studies have reported accelerated hemangioma growth in patients in patients with high estrogen states. […] The ACG recommends against the monitoring of both pregnant women and patients with large hemangiomas (ie, 10 cm). However, the authors of this chapter and others disagree. Patients with large hemangiomas may deserve long-term follow-up, perhaps with annual ultrasonography, because of their probable increased risk of complications. […] There are no commonly accepted medical treatments for hepatic hemangioma. Case reports have described the use of Bevacizumab, a monoclonal antibody that is used to inhibit vascular endothelial growth factor (VEGF) and Sorafenib, a multikinase inhibitor.

• #61 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  Liver hemangiomas are commonly the most frequent benign lesion of the liver. A liver hemangioma is qualified giant when it has a size larger than 5cm. Asymptomatic and non-complicated giant liver are managed conservatively by observation. However, lesion with incapacitating symptoms or complications is managed surgically. Surgery remains the most effective and radical therapeutic modality to treat liver hemangioma. Thus both enucleation and liver resection can be performed to remove the lesion. However recent studies demonstrated that enucleation was a safer, quicker surgical procedure and associated with lower complication and less blood loss. […] Severe incapacitating symptomatology or complications occurred during observation are justifiable of surgical management. Surgery is the most effective therapeutic modality to treat liver hemangioma. A hemangioma can be removed by enucleation or liver resection however, most authors advocated enucleation procedure.

• #62 Hepatic Hemangiomas Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/177106-treatment

  Most hemangioma surgeries are performed using an open approach, but laparoscopic surgery can be performed in some cases. […] The management of a large (ie, 10 cm) hepatic hemangioma is controversial. Certainly, large symptomatic hemangiomas should undergo treatment. However, the management of a large asymptomatic lesion is not as clear-cut. […] On rare occasions, liver transplantation has been offered to symptomatic patients with large or diffuse lesions. […] Less commonly used modalities for treating symptomatic hepatic hemangiomas include transarterial embolization of large feeding vessels, radiofrequency ablation, hepatic irradiation, and radiofrequency ablation. […] Transarterial embolization has been employed in cases in which surgical resection was not feasible on account of the massive or diffuse nature of the lesion, the tumors proximity to vascular structures, or the patient’s comorbidities.

• #63 Therapeutic options of giant liver hemangioma – MedCrave online

  https://medcraveonline.com/JLRDT/therapeutic-options-of-giant-liver-hemangioma.html

  Liver hemangiomas are commonly the most frequent benign lesion of the liver. A liver hemangioma is qualified giant when it has a size larger than 5cm. Asymptomatic and non-complicated giant liver are managed conservatively by observation. However, lesion with incapacitating symptoms or complications is managed surgically. Surgery remains the most effective and radical therapeutic modality to treat liver hemangioma. Thus both enucleation and liver resection can be performed to remove the lesion. However recent studies demonstrated that enucleation was a safer, quicker surgical procedure and associated with lower complication and less blood loss. […] Severe incapacitating symptomatology or complications occurred during observation are justifiable of surgical management. Surgery is the most effective therapeutic modality to treat liver hemangioma. A hemangioma can be removed by enucleation or liver resection however, most authors advocated enucleation procedure.

• #64 Surgical Management for Giant liver Hemangiomas Greater Than 20 cm in Size

  https://www.gutnliver.org/journal/view.html?pn=&uid=277&vmd=Full

  Most liver hemangiomas remain stable in size. It has been proposed that asymptomatic patients with hemangiomas less than 5 cm require no intervention therapy. […] Different treatment modalities of liver hemangiomas apart from resection have been described, such as ligation of hepatic artery or liver transplantation for giant unresectable lesions. […] Therefore, the treatment choice remains liver resection. […] For multiple giant liver hemangiomas, it is difficult to deal with all the lesions at one time for the reason of preservation of enough liver parenchyma, which is critical for the success of the operation. […] In conclusion, liver resection is indicated for giant liver hemangiomas with abdominal discomfort, especially for lesions greater than 20 cm, and staged operation is adopted for the patients with multiple lesions. Preoperative selective transcatheter arterial embolization is good to alleviate progressive abdominal pain, but no use to change the size of lesions.

• #65 Treatment Options for Liver Hemangioma

  https://www.medicoverhospitals.in/articles/liver-hemangioma-treatment

  In rare cases where the hemangioma is large and causing severe symptoms, a liver transplant may be considered. This is usually a last resort when other treatments have failed. […] Embolization is a minimally invasive procedure that involves injecting substances to block the blood supply to the hemangioma, causing it to shrink. This option is often chosen for patients who are not good candidates for surgery. […] Radiofrequency ablation uses heat to destroy the hemangioma. This is another minimally invasive option that can be effective for small to medium-sized hemangiomas. […] Treatments may include surgical removal, embolization, or radiation therapy.

• #66 Surgical Management for Giant liver Hemangiomas Greater Than 20 cm in Size

  https://www.gutnliver.org/journal/view.html?pn=&uid=277&vmd=Full

  Liver resection is indicated for giant liver hemangiomas with abdominal discomfort, especially for lesions greater than 20 cm in size. Staged operations are performed for patients with multiple lesions. Preoperative selective transcatheter arterial embolization alleviates progressive abdominal pain. […] The aim of this study was to investigate the primary management experience for giant liver hemangiomas greater than 20 cm in size. […] A retrospective analysis was performed for 14 patients diagnosed with a giant hemangioma on the basis of an imaging study and/or a histopathological examination. […] Twelve patients underwent liver resection, 2 of whom underwent staged resection. Enucleation was performed in 2 patients. Selective transcatheter arterial embolization was implemented in 9 patients.

• #67 Surgical Management for Giant liver Hemangiomas Greater Than 20 cm in Size

  https://www.gutnliver.org/journal/view.html?pn=&uid=277&vmd=Full

  Most liver hemangiomas remain stable in size. It has been proposed that asymptomatic patients with hemangiomas less than 5 cm require no intervention therapy. […] Different treatment modalities of liver hemangiomas apart from resection have been described, such as ligation of hepatic artery or liver transplantation for giant unresectable lesions. […] Therefore, the treatment choice remains liver resection. […] For multiple giant liver hemangiomas, it is difficult to deal with all the lesions at one time for the reason of preservation of enough liver parenchyma, which is critical for the success of the operation. […] In conclusion, liver resection is indicated for giant liver hemangiomas with abdominal discomfort, especially for lesions greater than 20 cm, and staged operation is adopted for the patients with multiple lesions. Preoperative selective transcatheter arterial embolization is good to alleviate progressive abdominal pain, but no use to change the size of lesions.

• #68 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangiomas account for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. […] The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.

• #69 【Liver hemangioma】➤ treatment and examination in clinics abroad ⚕️ MedTour

  https://medtour.help/clinics/i-liver-hemangioma/

  So-called vascular embolization, in which the blood vessels feeding the hemangioma are blocked, can slow or reverse its growth. […] Sclerosing is widely used. This method involves injecting a substance into the tumor cavity that glues its walls together and prevents the tumor from forming again. […] If this method is ineffective, surgical intervention is used: segmental liver resection; liver lobe removal. […] The choice of method of surgical treatment of hepatic hemangioma in men and women depends on the rate of its growth, severity of symptoms, presence or absence of complications. […] Direct indications for surgery are: tumor diameter more than 5 cm; increase in tumor size by 50% or more over a year; rupture of the tumor; signs of compression of surrounding tissues; suspected malignant nature of the tumor.

• #70 Hepatic Hemangioma | Texas Children’s

  https://www.texaschildrens.org/content/conditions/hepatic-hemangioma

  The choice of which treatment is best is individual and depends on: your child’s age, hemangioma characteristics (how big, how many hemangiomas, how much blood flow), how quickly the hemangioma is growing or involuting, and the type and severity of any associated complications. […] It is very important for your child to be monitored by the medical team until the hemangiomas have disappeared completely and not to stop the follow-up process at the beginning of involution period.

• #71 Outcomes of surgery for giant hepatic hemangioma | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01185-4

  Our data revealed no difference in the operative time, estimated blood loss, and major morbidity and mortality between laparoscopic and open liver resection for hepatic hemangioma, with a significant reduction in the length of stay associated with laparoscopic liver resection. Although our study was retrospective, we recommend laparoscopic hepatectomy as a treatment option for hepatic hemangioma. […] Hepatectomy should be performed by experienced hepatic surgeons.

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