Advertisement

Recent advances in surgical strategies for alveolar echinococcosis of the liver

  • Toshiya KamiyamaEmail author
Review Article
  • 26 Downloads

Abstract

Liver resection is the safest intervention for alveolar echinococcosis (AE), because the only potentially curative treatment is complete removal of the lesion. In combination with medical anthelmintic treatment, a safe distance of at least 1 mm is permissible in this procedure. Even when liver resection does not cure AE, good long-term survival outcomes can be achieved if most of the lesion has been removed and the disease is controlled with lifelong benzimidazole treatment. If the residual lesion is comparatively small and does not contain a closed space that may adhere to the surrounding tissue and form an abscess, complications such as sepsis arising from an abscess on the cut surface can be prevented and the required biliary drainage might be relatively simple. Larger AE lesions that invade the inferior vena cava can be treated effectively with the recent advances in reduction surgical techniques. An effective concentration of albendazole (ABZ) is found only in the periphery of AE lesions, because this drug penetrates the lesions passively. Liver transplantation, with adjuvant ABZ and the administration of appropriate immunosuppressive agents such as cyclosporin A, is indicated for patients with end-stage AE.

Keywords

Alveolar echinococcosis Liver Hepatectomy 

Abbreviations

AE

Alveolar echinococcosis

WHO

World Health Organization

IWGE

Informal Working Group on Echinococcosis

TNM

Tumor–node–metastasis

IVC

Inferior vena cava

ABZ

Albendazole

LT

Liver transplantation

LDLT

Living-donor liver transplantation

IS

Immunosuppressive status

Notes

Acknowledgements

I thank Ms. Ayumi Kondo for her assistance with this article.

Author contributions

The author was responsible for the conception and design of the study; literature review and analysis; drafting, critical revision, and editing; and approval of the final version.

Compliance with ethical standards

Conflict of interest

No potential financial or other conflicts of interest are declared. No financial support was received.

References

  1. 1.
    Eckert J, Deplazes P. Alveolar echinococcosis in humans: the current situation in Central Europe and the need for countermeasures. Parasitol Today. 1999;15:315–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Craig PS, Deshan L, MacPherson CN, Dazhong S, Reynolds D, Barnish G, et al. A large focus of alveolar echinococcosis in central China. Lancet. 1992;340:826–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Romig T, Kratzer W, Kimmig P, Frosch M, Gaus W, Flegel WA, et al. An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Romerstein Study Group. Am J Trop Med Hyg. 1999;61:566–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Gottstein B, Stojkovic M, Vuitton DA, Millon L, Marcinkute A, Deplazes P. Threat of alveolar echinococcosis to public health - a challenge for Europe. Trends Parasitol. 2015;31:407–12.PubMedCrossRefGoogle Scholar
  5. 5.
    https://idsc.niid.go.jp/iasr/26/309/kj3092.html. Infectious Agents Surveillance Report. Accessed 07 Oct 2019.
  6. 6.
    www.pref.aichi.jp/eiseiken/kansen/2018/201815.pdf. AICHI infectious diseases weekly report. Accessed 07 Oct 2019.
  7. 7.
    Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO informal working group on echinococcosis. Bull World Health Organ. 1996;74:231–42.Google Scholar
  8. 8.
    Vuitton DA, Bresson-Hadni S, Giraudoux P, Bartholomot B, Laplante J-J, Delabrousse E, et al. Échinococcose alvéolaire: D’une maladie rurale incurable à une infection urbaine sous contrôle? La Presse Médicale. 2010;39:216–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Torgerson PR, Schweiger A, Deplazes P, Pohar M, Reichen J, Ammann RW, et al. 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. 2008;49:72–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Ishizu H, Uchino J, Sato N, Aoki S, Suzuki K, Kuribayashi H. Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery. Hepatology. 1997;25:528–31.PubMedCrossRefGoogle Scholar
  11. 11.
    Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am. 1996;25:655–89.PubMedCrossRefGoogle Scholar
  12. 12.
    Bresson-Hadni S, Vuitton DA, Bartholomot B, Heyd B, Godart D, Meyer JP, et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol. 2000;12:327–36.PubMedCrossRefGoogle Scholar
  13. 13.
    Buttenschoen K, Schorcht P, Reuter S, Buttenschoen DC, Kern P, Beger HG. Surgical therapy of alveolar echinococcosis and long-term outcome. Chirurg. 2001;72:566–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Joliat GR, Melloul E, Petermann D, Demartines N, Gillet M, Uldry E, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg. 2015;39:2529–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Sato N, Namieno T, Furuya K, Takahashi H, Yamashita K, Uchino J, et al. Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis. J Gastroenterol. 1997;32:351–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Yamashita K, et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg. 2010;211:443–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589–94.PubMedCrossRefGoogle Scholar
  18. 18.
    Asiyanbola B, Chang D, Gleisner AL, Nathan H, Choti MA, Schulick RD, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg. 2008;12:842–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206 (Discussion 1206).PubMedCrossRefGoogle Scholar
  20. 20.
    Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg. 1999;229:322–30.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Kawamura N, Kamiyama T, Sato N, Nakanishi K, Yokoo H, Kamachi H, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg. 2011;212:804–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Hillenbrand A, Gruener B, Kratzer W, Kern P, Graeter T, Barth TF, et al. Impact of safe distance on long-term outcome after surgical therapy of alveolar echinococcosis. World J Surg. 2017;41:1012–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Chen KF, Tang YY, Wang R, Fang D, Chen JH, Zeng Y, et al. The choose of different surgical therapies of hepatic alveolar echinococcosis: a single-center retrospective case-control study. Medicine (Baltimore). 2018;97:e0033.CrossRefGoogle Scholar
  24. 24.
    Kern P, Wen H, Sato N, Vuitton DA, Gruener B, Shao Y, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int. 2006;55(Suppl):S283–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114:1–16.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Ayifuhan A, Tuerganaili A, Jun C, Ying-Mei S, Xiang-Wei L, Hao W. Surgical treatment for hepatic alveolar echinococcosis: report of 50 cases. Hepatogastroenterology. 2012;59:790–3.PubMedGoogle Scholar
  27. 27.
    Piarroux M, Piarroux R, Giorgi R, Knapp J, Bardonnet K, Sudre B, et al. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: results of a survey in 387 patients. J Hepatol. 2011;55:1025–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Buttenschoen K, Carli Buttenschoen D, Gruener B, Kern P, Beger HG, Henne-Bruns D, et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg. 2009;394:689–98.PubMedCrossRefGoogle Scholar
  29. 29.
    Kadry Z, Renner EC, Bachmann LM, Attigah N, Renner EL, Ammann RW, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg. 2005;92:1110–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Frei P, Misselwitz B, Prakash MK, Schoepfer AM, Prinz Vavricka BM, Mullhaupt B, et al. Late biliary complications in human alveolar echinococcosis are associated with high mortality. World J Gastroenterol. 2014;20:5881–8.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Graeter T, Ehing F, Oeztuerk S, Mason RA, Haenle MM, Kratzer W, et al. Hepatobiliary complications of alveolar echinococcosis: a long-term follow-up study. World J Gastroenterol. 2015;21:4925–32.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Buttenschoen K, Gruener B, Carli Buttenschoen D, Reuter S, Henne-Bruns D, Kern P. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg. 2009;394:199–204.PubMedCrossRefGoogle Scholar
  33. 33.
    Pavlidis ET, Symeonidis N, Psarras K, Pavlidis TE. Huge echinococcal cyst of the liver managed by hepatectomy: report of two cases. Int J Surg Case Rep. 2017;31:79–82.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Wakayama K, Kamiyama T, Yokoo H, Kakisaka T, Kamachi H, Tsuruga Y, et al. Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium. World J Surg Oncol. 2013;11:259.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Wang Y, Yuan L, Ge RL, Sun Y, Wei G. Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol. 2013;20:914–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Azoulay D, Andreani P, Maggi U, Salloum C, Perdigao F, Sebagh M, et al. Combined liver resection and reconstruction of the supra-renal vena cava: the Paul Brousse experience. Ann Surg. 2006;244:80–8.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Li W, Wu H. Multiorgan resection with inferior vena cava reconstruction for hepatic alveolar echinococcosis: a case report and literature review. Medicine (Baltimore). 2016;95:e3768.CrossRefGoogle Scholar
  38. 38.
    Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Cai SW, et al. Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J (Engl). 2009;122:2268–77.Google Scholar
  39. 39.
    Shen S, Kong J, Zhao J, Wang W. Outcomes of different surgical resection techniques for end-stage hepatic alveolar echinococcosis with inferior vena cava invasion. HPB (Oxford). 2019;21:1219–29.CrossRefGoogle Scholar
  40. 40.
    Kayaalp C, Aydin C, Olmez A. Is vena cava resection justified for hydatid liver cyst? J Gastrointest Surg. 2008;12:1618 (Author reply 1619).PubMedCrossRefGoogle Scholar
  41. 41.
    Taylor DH, Morris DL, Richards KS, Reffin D. Echinococcus multilocularis: in vivo results of therapy with albendazole and praziquantel. Trans R Soc Trop Med Hyg. 1988;82:611–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Saraner N, Ozkan GY, Guney B, Alkan E, Burul-Bozkurt N, Saglam O, et al. Determination of albendazole sulfoxide in human plasma by using liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2016;1022:1–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Bresson-Hadni S, Blagosklonov O, Knapp J, Grenouillet F, Sako Y, Delabrousse E, et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl. 2011;17:855–65.CrossRefGoogle Scholar
  44. 44.
    Vuitton DA, Azizi A, Richou C, Vuitton L, Blagosklonov O, Delabrousse E, et al. Current interventional strategy for the treatment of hepatic alveolar echinococcosis. Expert Rev Anti Infect Ther. 2016;14:1179–94.PubMedCrossRefGoogle Scholar
  45. 45.
    Kasai Y, Sasaki E, Koshino I, Kawanishi N, Kumagai M. Operative treatment of alveolar echinococcosis of the liver. Jpn J Surg. 1978;8:28–33.PubMedCrossRefGoogle Scholar
  46. 46.
    Koch S, Bresson-Hadni S, Miguet JP, Crumbach JP, Gillet M, Mantion GA, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation. 2003;75:856–63.PubMedCrossRefGoogle Scholar
  47. 47.
    Aydinli B, Ozturk G, Arslan S, Kantarci M, Tan O, Ahiskalioglu A, et al. Liver transplantation for alveolar echinococcosis in an endemic region. Liver Transpl. 2015;21:1096–102.PubMedCrossRefGoogle Scholar
  48. 48.
    Ozdemir F, Ince V, Barut B, Onur A, Kayaalp C, Yilmaz S. Living donor liver transplantation for Echinococcus Alveolaris: single-center experience. Liver Transpl. 2015;21:1091–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Chauchet A, Grenouillet F, Knapp J, Richou C, Delabrousse E, Dentan C, et al. Increased incidence and characteristics of alveolar echinococcosis in patients with immunosuppression-associated conditions. Clin Infect Dis. 2014;59:1095–104.PubMedCrossRefGoogle Scholar
  50. 50.
    Geyer M, Wilpert J, Wiech T, Theilacker C, Stubanus M, Kramer-Zucker A, et al. Rapidly progressive hepatic alveolar echinococcosis in an ABO-incompatible renal transplant recipient. Transpl Infect Dis. 2011;13:278–84.PubMedCrossRefGoogle Scholar
  51. 51.
    Weiner SM, Krenn V, Koelbel C, Hoffmann HG, Hinkeldey K, Ockert D. Echinococcus multilocularis infection and TNF inhibitor treatment in a patient with rheumatoid arthritis. Rheumatol Int. 2011;31:1399–400.PubMedCrossRefGoogle Scholar
  52. 52.
    Colebrook AL, Jenkins DJ, Jones MK, Tatarczuch L, Lightowlers MW. Effect of cyclosporin A on the survival and ultrastructure of Echinococcus granulosus protoscoleces in vitro. Parasitology. 2004;129:497–504.PubMedCrossRefGoogle Scholar
  53. 53.
    Wen H, Dong JH, Zhang JH, Duan WD, Zhao JM, Liang YR, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transpl. 2016;16:615–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan

Personalised recommendations