Laparoscopic microwave ablation for hepatic hemangiomas with different locations: A comparative study

BACKGROUND Hepatic hemangioma (HH) is the most common benign liver tumor. However, the relative impact of lesion location and tumor size on postoperative outcomes following trans-arterial embolization (TAE) combined with laparoscopic microwave ablation (LMWA) remains incompletely defined. In addition, heat-sink-related effects during ablation may contribute to perioperative complications, particularly in large or deeply located lesions. AIM To evaluate the association of lesion location and tumor size with short-term postoperative outcomes following TAE + LMWA under a standardized procedural protocol. METHODS This retrospective study included 152 patients with large or giant HH (GHH) who underwent TAE + LMWA. Lesions were categorized by location as subcapsular or parenchymal, and by size as large or GHHs. Perioperative parameters, postoperative complications, inflammatory markers, and hepatic and renal function indices were compared between groups. All patients were treated using a standardized ablation protocol incorporating a gas-blood outflow channel. RESULTS Lesion location was not significantly associated with most postoperative laboratory indices, although postoperative fever occurred more frequently in liver parenchymal than in liver subcapsular lesions. Tumor size demonstrated a more pronounced association with postoperative outcomes. Compared with large HH, GHH were associated with longer ablation times, greater intraoperative blood loss, delayed gastrointestinal recovery, and higher incidences of postoperative fever and hypoproteinemia. CONCLUSION Tumor size appears to be an important factor influencing short-term postoperative recovery following TAE + LMWA, whereas lesion location shows a limited and selective association. Under a standardized protocol incorporating a gas-blood decompression channel, a low incidence of major heat-sink-related complications was observed. However, given the retrospective design and absence of a control group, the potential role of this technical modification should be regarded as exploratory and requires prospective validation.