The Size and Localization of the Liver Haemangioma – Risk Factors for Massive Post-Resection Blood Loss

Hepatic haemangiomas are common benign liver tumours, often detected through advanced imaging and clinically significant when large or symptomatic. The objective of this study was to determine how tumour size, location, and associated operative factors influence perioperative outcomes, specifically focusing on the risk of massive blood loss. This single-centre retrospective-prospective analysis included 101 patients with cavernous haemangioma who underwent resection or enucleation between 2010 and 2023, with retrospective cases covering surgeries from 2010 to 2020 and prospective cases from 2021 to 2023, evaluating tumour diameter, intraoperative technique, and use of vascular control manoeuvres. The sample showed intraoperative blood loss ranging from 20 ml to 400 ml, with an average of 173.5 ml. Bilateral tumours had the highest mean blood loss (249.167 ml), followed by right-sided lesions (189.286 ml), central lesions (158.571 ml), and left-sided lesions (149.255 ml). Larger tumours correlated positively with blood loss (Pearson correlation 0.333; p=0.001), and an increase of 1 cm in diameter corresponded to an additional 3.744 ml of bleeding. For patients with borderline hemodynamic stability, this additional 3.744 mL of bleeding could exacerbate existing circulatory challenges, potentially requiring more intensive monitoring and interventions to maintain stable hemodynamics during surgery. The Pringle manoeuvre, used in 35% of the operations, was tied to a higher observed average blood loss (223.714 ml) relative to cases without vascular inflow occlusion (146.894 ml). This study refines preoperative risk stratification based on tumour size, localization, and vascular involvement, guiding surgical techniques to minimize intraoperative blood loss in hepatic haemangioma resection.