Cavernous hemangiomas of the liver: are there any indications for resection?

A total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio-computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty-seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n = 8), embolization (n = 5), or hepatic artery ligation (n = 1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty-five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.