Historical and Contemporary Management of Infantile Hepatic Hemangioma: A 30-year Single-center Experience

• Published in: Annals of surgery Vol. 275; no. 1; p. e250
• Main Authors: Macdonald, Alexander, Durkin, Natalie, Deganello, Annamaria, Sellars, Maria E, Makin, Erica, Davenport, Mark
• Format: Journal Article
• Language: English
• Published: United States 01.01.2022
• Subjects: Adolescent; Adrenergic beta-Antagonists - therapeutic use; Child; Child, Preschool; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Forecasting; Hemangioma - classification; Hemangioma - diagnosis; Hemangioma - therapy; Humans; Infant; Infant, Newborn; Liver Neoplasms - classification; Liver Neoplasms - diagnosis; Liver Neoplasms - therapy; Male; Neoplasm Staging - methods; Propranolol - therapeutic use; Retrospective Studies; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasonography
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000003881

To describe outcome of infants with hemangioma(s) of the liver. Infantile hepatic hemangiomas exhibit a diverse phenotype. We report our 30-year experience and describe optimal management based on precise radiological classification. Retrospective review of 124 infants (66 female) 1986-2016. Categorical analysis with Chi2 and nonparametric comparison. Data expressed as median (range) and P < 0.05 considered significant. Lesions classified as focal (n = 70, 56%); multifocal (n = 47, 38%) or diffuse (n = 7, 6%) and of these 80(65%) were symptomatic (eg, cardiac failure n = 39, 31%; thrombocytopenia n = 12, 10%).Increased hepatic artery velocity was seen in 63 (56%). Median hepatic artery velocity was greatest in diffuse lesions [245 (175-376) cm/s vs focal 120 (34-242) cm/s vs multifocal 93 (36-313) cm/s; P = 0.0001]. Expectant management alone was followed in 55 (44%). Medical therapy was utilised in 57(46%) and sufficient for symptom control in 29/57 (51%). Propranolol therapy (from 2008) was sufficient for symptom control in 22/28 (79%). Surgery (hepatic artery ligation n = 26; resection n = 13; embolization n = 1) was required in 40 (32%). Median maximal lesion diameter was 3 (0.5-17.1) cm and greater in those requiring surgery (7 cm vs 4.9 cm; P = 0.04). The proportion requiring surgery decreased markedly in the propranolol era [pre-propranolol 25/48 (52%) vs post-propranolol 16/76 (21%) (P = 0.0003)]. Systematic follow-up with ultrasound to a median of 2.6 (0.02-16) years. A proportion of infantile hepatic hemangiomas remain asymptomatic permitting observation until resolution but the majority require complex multi-modal therapy. First-line pharmacotherapy with propranolol has reduced but not abolished the need for surgery.