Limiting the surgical indications for liver hemangiomas may help surgeons and patients.

摘要

We much appreciated the manuscript of Schnelldorfer and coworkers about the management of giant hemangiomas of the liver.The treatment of liver hemangiomas is well established, and many clinicians consider hepatic hemangiomas of larger than 10 cm as giant. Hemangiomas smaller than 10 cm are less likely to be clinically symptomatic, which decreases the need for operations because they are only indicated for symptomatic patients. For example, in a patient who has a hemangioma located on the left lobe of the liver, the stomach is compressed, giving the patient early satiety after meals. However, usually patients with hemangiomas with similar characteristics but with no relationship between symptoms and the tumor should be observed, not treated surgically. Probably patients with giant hemangiomas should be surgically treated only in cases of Kasabach Merritt syndrome, organ compression with symptoms, and rupture of the tumor.2 In other cases, operations should be avoided.