Radiofrequency ablation for large hepatic hemangiomas: Initial experience and lessons

Objective. We aimed to assess the feasibility, safety, and efficacy of radiofrequency (RE) ablation for the treatment of large (>= 5 cm in greatest diameter) hepatic hemangiomas. Methods. Thirty-six patients (15 male, 21 female; mean age 50 years) with 41 hepatic hemangiomas >= 5 cm in diameter were enrolled and treated with RE ablation attributable to the presence of enlargement tendency and/or persistent hemangioma-associated symptoms. Twenty patients had 24 hemangiomas <10 cm, and 16 patients had 17 hemangiomas >= 10 cm. Technical success, complications related to RE ablation, completed ablation, symptom relief change in size of ablation zone, and recurrence of the residual tumor were analyzed. Results. Of the 41 hemangiomas with a mean diameter 10 +/- 4 cm (range, 5-22 cm), 26 subcapsular lesions were treated with a laparoscopic approach, and 15 lesions located in liver parenchyma underwent a computed tomography guided percutaneous approach. RE ablation was performed successfully in all patients. There were 62 complications related to the ablation in 22 patients, including 6 of 20 patients with hemangiomas <10 cm and all the 16 patients with hemangiomas >= 10 cm. According to the Dindo-Clavien classification, 2 complications (lower esophageal fistula and acute respiratory distress syndrome, Grade III and Grade IV, respectively) were major in 2 patients with hemangiomas >= 10 cm; all the other were minor in 20 patients (Grade I). All the complications were recovered by conservative treatment. Thirty-eight (93%) of 41 hepatic hemangiomas were ablated completely, including all the 24 lesions <10 cm and 14 of 17 lesions >= 10 cm. All the symptoms related to hemangiomas disappeared (n = 22) or were ameliorated (n = 4) after ablation. The mean diameter of ablation zone was decreased to 6 +/- 3 cm (2-12 cm) in a mean follow-up period (X +/- SD) of 15 +/- 6 months (range, 6-24 months), without recurrence or enlargement of the 3 residual tumors. Conclusion. The present study supports RE ablation as an alternative treatment for hepatic hemangiomas >= 5 cm (but smaller than 10 cm) for the low risk of complications and likelihood of complete ablation, but, in contrast, RE ablation appears to be an inappropriate method for hepatic hemangiomas >= 10 cm because of the high occurrence rate of complications. (Surgery 2013; 153:78-85.)