Treatment of hepatic hemangiomas in the era of laparoscopic surgery: Enucleation versus hepatectomy

Objective To evaluate the safety and efficacy of laparoscopic enucleation versus laparoscopic hepatectomy for hepatic hemangioma using propensity score matching to adjust for confounding factors. Methods This retrospective cohort study used data from consecutive patients who underwent laparoscopic surgery for pathologically confirmed hepatic hemangioma at our hospital from January 2019 to December 2023. Patients were divided into laparoscopic hepatectomy and laparoscopic enucleation groups. Propensity score matching (1:1 nearest neighbor matching) was performed to balance the confounding variables. Balance was assessed using standardized mean differences. Perioperative indicators of the matched cohorts were statistically analyzed. Results In total, 100 patients (40 with laparoscopic enucleation and 60 with laparoscopic hepatectomy) were initially included, with 34 pairs (68 patients) successfully matched. Laparoscopic enucleation was associated with superior outcomes in terms of intraoperative blood loss (median (interquartile range): 100.0 (50.0–200.0) mL vs. 400.0 (100.0–600.0) mL, p = 0.001), blood transfusion rate (11.8% vs. 47.1%, p = 0.003), and postoperative hospital stay (5.0 (4.0–6.0) days vs. 7.0 (5.0–8.0) days, p = 0.004). There were no significant differences in the operative time, hepatic vascular occlusion time, and postoperative complication rate between the groups. No postoperative complications occurred in either group after propensity score matching, precluding meaningful comparison of safety profiles. No mortality was observed within 30 days postoperatively. Conclusion After propensity score matching, laparoscopic enucleation for hepatic hemangioma was associated with lower intraoperative blood loss, reduced transfusion requirement, and shorter hospital stay compared with laparoscopic hepatectomy, with similar complication rates and short-term mortality. These findings should be interpreted cautiously due to the retrospective study design and limitations associated with propensity score matching.