Diagnosis and surgical decision-making in hepatic hemangioma: From venous malformation overlap to artificial intelligence-assisted multimodality imaging

Table 5 How diagnostic classification influences interventional and surgical decision-making

Comparison	Evidence summary	Practical implication for a diagnosis-focused review
Observation vs intervention	Many asymptomatic HHs remain stable or enlarge slowly, and lesion size alone is a poor isolated indication for treatment	Observation is generally preferred when diagnostic certainty is high and symptoms are absent or not clearly attributable to the lesion. Intervention is considered when symptoms, compression, complications, or diagnostic uncertainty affect management
Percutaneous sclerotherapy vs transarterial embolization/chemoembolization	Recent pooled analyses suggest similarly high technical success and comparable clinical or radiological response, with low major complication rates	If giant adult lesions are framed as low-flow venous malformations, sclerotherapy becomes a rational alternative rather than a marginal option
Percutaneous sclerotherapy vs surgical resection	Retrospective data suggest both can be effective for selected large lesions, with different trade-offs in efficacy, invasiveness, and resource use	Atypical or indeterminate lesions still require secure diagnosis before non-surgical treatment is chosen
Laparoscopic vs open resection	Meta-analysis and propensity-matched cohorts generally favor laparoscopy in selected peripheral lesions due to reduced blood loss, shorter stay, and faster recovery	Minimally invasive surgery is an anatomic consequence of diagnosis; it is not a universal answer for every giant or central lesion
Robotic vs laparoscopic/open resection	Robotic approaches may shorten postoperative recovery in selected patients, but cost, access, and lesion complexity remain major determinants	Robotics is most persuasive when preoperative imaging defines anatomy precisely and malignancy has been reasonably excluded

HH: Hepatic hemangioma.