Clinical Presentation and Surgical Management of Liver Hemangioma: A Single-center Retrospective-prospective Study of 101 Cases

The aim of this study was to evaluate the correlation between tumour size and the clinical manifestation of hepatic hemangiomas, with the overarching goal of improving criteria for surgical decision-making. This study was conducted at the Surgery Clinics of the Military Medical Academy in Sofia, Bulgaria, between 2010 and 2023, and analysed clinical presentation, imaging diagnosis, and surgical management of hepatic hemangiomas in 101 patients based on prospective and retrospective data. Approximately 58.42% of patients presented with such symptoms as abdominal discomfort, and palpable masses during examination, while another 31.68% incidentally discovered the condition, highlighting the importance of routine imaging. Statistical analyses revealed a very strong positive correlation between the tumour size and the intensity of clinical symptoms (Spearman’s rs=0.628, p<0.001) and hence, larger lesions were more likely to produce symptomatic manifestations. It was further shown through logistic regression that patients above 75 years had an 18-fold increase in the chances of diagnostic uncertainty than younger patients (odds ratio = 18.8%, confidence interval: 1.5–217.8, p=0.023). Despite the presence of variations in tumour size and presentation, operative outcomes remained consistent across both symptomatic and asymptomatic groups. These findings provided a robust rationale for the implementation of a standardized, size-based classification system to guide clinical decision-making and personalized treatment strategies. The results of this study provide practical guidance for improving the selection criteria for surgical intervention in hepatic hemangiomas, enabling clinicians to better stratify patients based on tumour size, symptomatology, and diagnostic clarity.