Laparoscopic anatomical liver resection versus enucleation in the treatment of giant hepatic hemangioma larger than 10 cm: a retrospective study

BACKGROUND: Hepatic hemangiomas (HH) are the most common benign liver tumors. This study aimed to provide a clinical basis for selecting the most appropriate surgical approach for managing giant hepatic hemangiomas (> 10 cm). METHODS: We retrospectively analyzed clinical data from 126 patients with giant hepatic hemangiomas treated at our hospital between January 2019 and May 2025. Of these, 54 had right hemi-hepatic hemangiomas, and 72 had left hemi-hepatic hemangiomas. Patients were divided into laparoscopic anatomical liver resection (LR) and laparoscopic hemangioma enucleation (LE) groups based on surgical approaches. Intraoperative parameters, postoperative outcomes, length of hospital stay, and complication rates were compared between the two groups. RESULTS: No cases required conversion to open surgery. In patients with right hemi-hepatic hemangiomas, LE showed significantly shorter operative time [230.0 (175.0, 280.0) vs. 355.0 (235.0, 555.0) min, P = 0.001], shorter occlusion time [30.0 (15.0, 45.0) vs. 55.0 (45.0, 77.5) min, P < 0.05], less blood loss [200 vs. 300 mL, P < 0.001], and fewer autologous blood transfusions [12 vs. 15, P < 0.05] compared to LR. In contrast, no significant differences were observed in operative or postoperative outcomes between LR and LE for left hemi-hepatic hemangiomas (P > 0.05). Overall, across the entire cohort, there were no significant differences in operative time, occlusion time, hospital stay, or complication rates between LR and LE groups. CONCLUSION: Both LR and LE are safe and effective for treating giant hepatic hemangiomas. However, LE is particularly recommended for right hemi-hepatic hemangiomas, due to shorter operative and occlusion times, reduced intraoperative blood loss, and greater preservation of normal liver tissue.