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Long-term experience on surgical treatment of alveolar echinococcosis

  • Klaus ButtenschoenEmail author
  • Daniela Carli Buttenschoen
  • Beate Gruener
  • Peter Kern
  • Hans G. Beger
  • Doris Henne-Bruns
  • Stefan Reuter
Original Article

Abstract

Introduction

Alveolar echinococcosis (AE) is life-threatening and reports on surgical procedures and results are rare, but essential.

Materials and methods

Longitudinal surveillance and long-term follow-up of patients surgically treated for AE during the periods 1982–1999 (group A) and 2000–2006 (group B).

Setting

University hospital within an endemic area.

Results

The median (min–max) follow-up period was 141 (5–417) months. Forty-eight surgical procedures were performed in 36 patients with AE: 63% were partial resections of the liver (additional extrahepatic resection in ten of them), 17% just extrahepatic resections, 10% biliodigestive anastomosis, and 10% exploratory laparotomies. Seventy-five percent of the operations were first-time procedures, 25% done due to a relapse. Forty-two percent of the operations were estimated to be curative (R0), whereas 58% were palliative (R1, R2). All patients had additional medical treatment and periodical follow-up. Two out of 18 (11%) patients, estimated to have had curative surgery, developed a relapse 42 and 54 months later. R0-resection rates depended on the primary, neighboring, metastasis stage of AE (S1, 100%; S2, 100%; S3a, 33%; S3b, 27%; S4, 11%). During the period 2000–2006 elective radical surgery for AE was done only if a safe distance of at least 2 cm was attainable. This concept was associated with an increased R0-resection rate of 87% for group B compared to 24% for group A. Operative procedures done to control complicated courses of AE (jaundice, cholangitis, vascular compression, bacterial superinfection) have not been curative (R2) in 82% because the disease had spread into irresectable structures. Morbidity was 19%. All patients with curative resections are alive. Fifty-six percent of the patients with palliative treatment are alive as long as 14–237 months, 28% died from AE 164–338 months after diagnosis (late lethality), and 17% died due to others diseases 96–417 months after diagnosis of AE. One out of seven (14%) patients suffering from suppurative parasitic necrosis died because it was impossible to control systemic sepsis (3% hospital lethality).

Conclusion

Curative surgery for AE is feasible if the parasitic mass is removable entirely. The earlier the stage, the more frequent is R0 resectability. The observance of a minimal safe distance increases the rate of R0 resections. The benefit of palliative surgery is uncertain due to favorable long-term results of medical treatment alone. However, necrotic tissue is at risk of bacterial superinfection, which can cause life-threatening sepsis. Palliative surgery is an option to treat complications, which could not be managed otherwise.

Keywords

Alveolar echinococcosis Surgical procedures Curability Palliation Long-term follow-up 

Notes

Acknowledgment

The authors do very appreciate the comprehensive advice of Professor Dr. R. Muche, Department of Biostatistics, University of Ulm.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Klaus Buttenschoen
    • 1
    Email author
  • Daniela Carli Buttenschoen
    • 3
  • Beate Gruener
    • 2
  • Peter Kern
    • 1
  • Hans G. Beger
    • 1
  • Doris Henne-Bruns
    • 1
  • Stefan Reuter
    • 2
  1. 1.Department of General SurgeryUniversity of UlmUlmGermany
  2. 2.Division of Infectious Diseases and Clinical Immunology, Internal MedicineUniversity of UlmUlmGermany
  3. 3.Department of AnaesthesiologyDonau-KlinikNeu-UlmGermany

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