Management and Clinical Outcomes of Liver Hemangiomas: A Retrospective Comparative Study of Transcatheter Arterial Embolization and Surgery

Background and Objectives: Hemangiomas are the most common benign tumors of the liver. Surgical options such as enucleation, segmentectomy, and hepatectomy are the primary treatment choices, though the morbidity and complication rates remain high. Transcatheter arterial embolization (TAE) has emerged as a safe and effective alternative treatment option that has gained popularity in recent years. Materials and Methods: We retrospectively evaluated data from patients who underwent either surgical intervention (n = 19) or transarterial embolization (62 lesions in 61 patients; analyses performed per treated lesion) for liver hemangioma between 2003 and 2021. Outcomes were assessed separately for each modality without a composite efficacy endpoint: clinical success (relief of the presenting symptoms, assessed in patients symptomatic at baseline), technical success and radiological response for embolization, treatment-related complications, length of hospital stay, and the need for reintervention. Results: There was no significant difference in the pretreatment size of the lesions between the TAE and surgery groups (median of 10.0 [IQR 7.8–13.9] versus 10.0 [IQR 9.0–17.0] cm; p = 0.100). The length of hospital stay was shorter in the TAE group (median of 1 versus 6 days; p < 0.001), although era-related differences in perioperative care may contribute to this difference, and follow-up was longer in surgically treated patients, reflecting the later adoption of embolization at our institution. Postoperative mortality did not occur in either group. In the embolization group, there were significant reductions in lesion size and volume and the complication rate was low, with no serious complications, supporting the safety profile of TAE. Conclusions: In this retrospective, non-randomized, single-center series, transarterial embolization was found to be a safe and effective minimally invasive treatment for liver hemangiomas and was associated with a shorter hospital stay. Because treatment allocation was not randomized, we cannot establish therapeutic equivalence between the two modalities, and the comparison should be regarded as descriptive; TAE represents an effective minimally invasive treatment option in appropriately selected patients and may be considered within a multidisciplinary treatment strategy, while surgery remains necessary in selected cases such as embolization failure, complicated lesion vascularization, or localization.