Surgery vs. Observation for Liver Hemangioma: A Systematic Review and Meta-analysis

Background/Aims: To conduct a systematic review of observational studies to evaluate effectiveness of surgery for liver hemangioma. Methodology: Related studies were identified using different searching engines. Two reviewers independently extracted data on mortality morbidity and symptoms recurrence and/or aggravation. Results: Sixteen studies with a total of 1485 patients (402 in surgery and 1085 in observation group) were included in the analysis. Two deaths in surgical group (8.0%, 2/25) and two deaths in observation group (1.4%, 2/143) were reported. The RRs for mortality were not homogeneous (chi(2)=3.40, 1 d.f., P=0.07, I-2=71 per cent). The RRs for morbidity were homogeneous across studies (x(2)=5.55, 12 d.f., P=0.94, I-2=0 per cent). Morbidity in surgery group was significantly higher than that in observation group (RR=14.7, 95 per cent c.i. 9.56 to 45.63). Eight studies reported the symptom aggravation and RRs were heterogeneous (x(2)=31.03, 7 d.f., P < 0.0001, I-2 = 77 per cent), However, showed no statistical difference. Conclusion: The currently involved retrospective cohort studies of surgical series were likely to imply that surgery may take more risks than the benefits for non-emergency hemangioma patients.