Abstract
Background
Switzerland is a region in which alveolar echinococcosis (AE) is endemic. Studies evaluating outcomes after liver resection (LR) for AE are scarce. The aim of this study was to assess the short- and long-term outcomes of AE patients after LR in a single tertiary referral center.
Methods
We retrospectively analyzed data pertaining to all patients with liver AE who were treated with LR at our institution between January 1992 and December 2013. Patient demographics, intraoperative data, extent of LR procedures (major vs. minor LR), postoperative outcomes, and negative histological margin (R0) resection rate were recorded in a database. Recurrence rates after LR were analyzed.
Results
LR was performed in 59 patients diagnosed with hepatic AE (56 complete surgeries, 3 reduction surgeries). Postoperative morbidity and mortality were observed in 34 % (25 % grade I–II, 9 % grade III–IV) and 2 % of the patients, respectively. R0 (complete) resection rate was 71 % (n = 42), and R1/R2 resection rate was 29 % (n = 17). Extra-hepatic recurrence occurred in 1 case (lung) after R0 resection. In cases of R1/R2 resection, 7 intra-hepatic disease progressions occurred with a median time of 10 months (IQR 6–11 months). Long-term (more than 1 year) benzimidazole treatment stabilized the disease in 64 % (9/14) of patients with R1 status. The overall survival rate was 97 %.
Conclusions
Liver AE can be safely and definitively treated with LR, provided that R0 resection is achieved. In cases of R1 resection, benzimidazole therapy seems to be effective in stabilizing the intra-hepatic disease and preventing extra-hepatic recurrence.
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References
Eckert J, Deplazes P (2004) Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 17:107–135
Ammann RW, Eckert J (1996) Cestodes. Echinococcus. Gastroenterol Clin North Am 25:655–689
Craig P (2003) Echinococcus multilocularis. Curr Opin Infect Dis 16:437–444
Schweiger A, Ammann RW, Candinas D et al (2007) Human alveolar echinococcosis after fox population increase, Switzerland. Emerg Infect Dis 13:878–882
Kern P, Wen H, Sato N et al (2006) WHO classification of alveolar echinococcosis: principles and application. Parasitol Int 55(Suppl):S283–S287
Kawamura N, Kamiyama T, Sato N et al (2011) Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg 212:804–812
Torgerson PR, Schweiger A, Deplazes P et al (2008) Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J Hepatol 49:72–77
Bresson-Hadni S, Vuitton DA, Bartholomot B et al (2000) A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol 12:327–336
Kasai Y, Koshino I, Kawanishi N et al (1980) Alveolar echinococcosis of the liver; studies on 60 operated cases. Ann Surg 191:145–152
Dulger AC, Esen R, Begenik H et al (2012) Alveolar echinococcosis of the liver: a single center experience. Pol Arch Med Wewn 122:133–138
Wilson JF, Rausch RL, Wilson FR (1995) Alveolar hydatid disease. Review of the surgical experience in 42 cases of active disease among Alaskan Eskimos. Ann Surg 221:315–323
Kadry Z, Renner EC, Bachmann LM et al (2005) Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg 92:1110–1116
Buttenschoen K, Carli Buttenschoen D, Gruener B et al (2009) Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg 394:689–698
Kodama Y, Fujita N, Shimizu T et al (2003) Alveolar echinococcosis: MR findings in the liver. Radiology 228:172–177
Becce F, Pomoni A, Uldry E et al (2014) Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 83:625–631
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Emre A, Ozden I, Bilge O et al (2003) Alveolar echinococcosis in Turkey. Experience from an endemic region. Dig Surg 20:301–305
McManus DP, Zhang W, Li J et al (2003) Echinococcosis. Lancet 362:1295–1304
Sato N, Namieno T, Furuya K et al (1997) Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis. J Gastroenterol 32:351–354
Liu YH, Wang XG, Gao JS et al (2009) Continuous albendazole therapy in alveolar echinococcosis: long-term follow-up observation of 20 cases. Trans R Soc Trop Med Hyg 103:768–778
Ammann RW, Fleiner-Hoffmann A, Grimm F et al (1998) Long-term mebendazole therapy may be parasitocidal in alveolar echinococcosis. J Hepatol 29:994–998
Ozturk G, Polat KY, Yildirgan MI et al (2009) Endoscopic retrograde cholangiopancreatography in hepatic alveolar echinococcosis. J Gastroenterol Hepatol 24:1365–1369
Sezgin O, Altintaş E, Saritaş U et al (2005) Hepatic alveolar echinococcosis: clinical and radiologic features and endoscopic management. J Clin Gastroenterol 39:160–167
Vogel J, Görich J, Kramme E et al (1996) Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd–Chiari syndrome. Gut 39:762–764
Brunetti E, Kern P, Vuitton DA et al (2010) Expert consensus for the diagnosis and treament of cystic and alveolar echinococcosis in humans. Acta Trop 114:1–16
Ishizu H, Uchino J, Sato N et al (1997) Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery. Hepatology 25:528–531
Ito A, Nakao M, Kutsumi H et al (1993) Serodiagnosis of alveolar hydatid disease by western blotting. Trans R Soc Trop Med Hyg 87:170–172
Liance M, Janin V, Bresson-Hadni S et al (2000) Immunodiagnosis of Echinococcus infections: confirmatory testing and species differentiation by a new commercial Western Blot. J Clin Microbiol 38:3718–3721
Gottstein B, Jacquier P, Bresson-Hadni S et al (1993) Improved primary immunodiagnosis of alveolar echinococcosis in humans by an enzyme-linked immunosorbent assay using the Em2plus antigen. J Clin Microbiol 31:373–376
Caoduro C, Porot C, Vuitton DA et al (2013) The role of delayed 18F-FDG PET imaging in the follow-up of patients with alveolar echinococcosis. J Nucl Med 54:358–363
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Joliat, GR., Melloul, E., Petermann, D. et al. Outcomes After Liver Resection for Hepatic Alveolar Echinococcosis: A Single-Center Cohort Study. World J Surg 39, 2529–2534 (2015). https://doi.org/10.1007/s00268-015-3109-2
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DOI: https://doi.org/10.1007/s00268-015-3109-2