A Single-Center Experience on Surgical Treatment of Hepatic Echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGHan-zhi ,  CHENZhe-yu , YANLü-nan , ZENGYong , LIBo , WENTian-fu , WANGWen-tao , WUHong , YANGJia-yin , HUANGJi-wei , LIJia-xin , WANGJing-chen

Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

CHENZhe-yu, Email: chenzheyu71@163.com

Keywords：

Hepatic echinococcosis; Endocystectomy; Total cystectomy; Hepatectomy; Liver transplantation

DOI：

10.7507/1007-9424.20150040

Video：

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Objective To evaluate and discuss the various surgical methods for hepatic echinococcosis. Methods Four hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results ①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions ①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.

Citation： ZHANGHan-zhi, CHENZhe-yu, YANLü-nan, ZENGYong, LIBo, WENTian-fu, WANGWen-tao, WUHong, YANGJia-yin, HUANGJi-wei, LIJia-xin, WANGJing-chen. A Single-Center Experience on Surgical Treatment of Hepatic Echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 144-148. doi: 10.7507/1007-9424.20150040 Copy

1.	Grosso G, Gruttadauria S, Biondi A, et al. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol, 2012, 18(13): 1425-1437.
2.	Morakote N, Thamprasert K, Lojanapiwat B, et al. Cystic echinococcosis in Thailand with a special note on detection by serology in one family. Southeast Asian J Trop Med Public Health, 2007, 38(5): 796-798.
3.	Maoz D, Greif F, Chen J. Operative treatment of hepatic hydatid cysts: a single center experience in Israel, a nonendemic country. ISRN Surg, 2013, 2013: 276807.
4.	Eckert J, Conraths FJ, Tackmann K. Echinococcosis: an emerging or re-emerging zoonosis? Int J Parasitol, 2000, 30: 1283-1294.
5.	Eckert J, Schantz PM, Gasser RB, et al. Geographic distribution and prevalence//Eckert J, Gemmell MA, Meslin FX, et al, editors. WHO/OIE Manual on Echinococcosis in Humans and Animals: a Public Health Problem of Global Concern. Paris: Office International des Epizooties Paris, 2001: 100-142.
6.	Gollackner B, Langle F, Auer H, et al. Radical surgical therapy of abdominal cystic hydatid disease: Factors of recurrence. World J Surg, 2000, 24(6): 717-721.
7.	Akbulut S, Senol A, Sezgin A, et al. Radical vs conservative surgery for hydatid liver cysts: Experience from single center. World J Gastroenterol, 2010, 28: 16(8): 953-959.
8.	Safioleas M, Misiakos E, Manti C, et al. Diagnostic evaluation and surgical management of hydatid disease of the liver. World J Surg, 1994, 18(6): 859-865.
9.	Bilge A, Sözüer EM. Diagnosis and surgical treatment of hepatic hydatid disease. HPB Surg, 1994, 8(2): 77-81．.
10.	Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3): 231-242.
11.	Aydin U, Yazici P, Onen Z, et al. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence. Turk J Gastroenterol, 2008, 19(1): 33-39.
12.	Abu Zeid M, El-Eibiedy G, Abu-El-Einien A, et al. Surgical treatment of hepatic hydatid cysts. Hepatogastroenterology, 1998, 45(23): 1802-1806．.
13.	Birnbaum DJ, Hardwigsen J, Barbier L, et al. Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg, 2012, 16(11): 2086-2093.
14.	Landen S, Van de Sande J, Berger P, et al. Alveolar echinococcosis in a Belgian urban dweller. Acta Gastroenterol Belg, 2013, 76(3): 317-321.
15.	Buttenschoen K, Kern P, Reuter S, et al. Hepatic infestation of Echinococcus multilocularis with extension to regional lymph nodes. Langenbecks Arch Surg, 2009, 394(4): 699-704.
16.	Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(4): 689-698.
17.	Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
18.	Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1): 199-204.
19.	Brunetti E1, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
20.	Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosis-spreading disease challenging clinicians: a case report and literature review. World J Gastroenterol, 2013, 19(26): 4257-4261.
21.	Li FQ, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
22.	Bresson-Hadni S, Blagosklonov O, Knapp J, 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(7): 855-865.
23.	Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
24.	Vuitton DA, Zhang SL, Yang Y, et al. Survival strategy of echinococcus multilocularis in the human host. Parasitol Int, 2006, 55(Suppl): S51-S55.
25.	Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
26.	Rajesh R, Dalip DS, Anupam J, et al. Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts. Iran J Radiol, 2013, 10(2): 68-73.

1. Grosso G, Gruttadauria S, Biondi A, et al. Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol, 2012, 18(13): 1425-1437.
2. Morakote N, Thamprasert K, Lojanapiwat B, et al. Cystic echinococcosis in Thailand with a special note on detection by serology in one family. Southeast Asian J Trop Med Public Health, 2007, 38(5): 796-798.
3. Maoz D, Greif F, Chen J. Operative treatment of hepatic hydatid cysts: a single center experience in Israel, a nonendemic country. ISRN Surg, 2013, 2013: 276807.
4. Eckert J, Conraths FJ, Tackmann K. Echinococcosis: an emerging or re-emerging zoonosis? Int J Parasitol, 2000, 30: 1283-1294.
5. Eckert J, Schantz PM, Gasser RB, et al. Geographic distribution and prevalence//Eckert J, Gemmell MA, Meslin FX, et al, editors. WHO/OIE Manual on Echinococcosis in Humans and Animals: a Public Health Problem of Global Concern. Paris: Office International des Epizooties Paris, 2001: 100-142.
6. Gollackner B, Langle F, Auer H, et al. Radical surgical therapy of abdominal cystic hydatid disease: Factors of recurrence. World J Surg, 2000, 24(6): 717-721.
7. Akbulut S, Senol A, Sezgin A, et al. Radical vs conservative surgery for hydatid liver cysts: Experience from single center. World J Gastroenterol, 2010, 28: 16(8): 953-959.
8. Safioleas M, Misiakos E, Manti C, et al. Diagnostic evaluation and surgical management of hydatid disease of the liver. World J Surg, 1994, 18(6): 859-865.
9. Bilge A, Sözüer EM. Diagnosis and surgical treatment of hepatic hydatid disease. HPB Surg, 1994, 8(2): 77-81．.
10. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ, 1996, 74(3): 231-242.
11. Aydin U, Yazici P, Onen Z, et al. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence. Turk J Gastroenterol, 2008, 19(1): 33-39.
12. Abu Zeid M, El-Eibiedy G, Abu-El-Einien A, et al. Surgical treatment of hepatic hydatid cysts. Hepatogastroenterology, 1998, 45(23): 1802-1806．.
13. Birnbaum DJ, Hardwigsen J, Barbier L, et al. Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg, 2012, 16(11): 2086-2093.
14. Landen S, Van de Sande J, Berger P, et al. Alveolar echinococcosis in a Belgian urban dweller. Acta Gastroenterol Belg, 2013, 76(3): 317-321.
15. Buttenschoen K, Kern P, Reuter S, et al. Hepatic infestation of Echinococcus multilocularis with extension to regional lymph nodes. Langenbecks Arch Surg, 2009, 394(4): 699-704.
16. Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(4): 689-698.
17. Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg, 2005, 92(9): 1110-1116.
18. Buttenschoen K, Gruener B, Carli Buttenschoen D, et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg, 2009, 394(1): 199-204.
19. Brunetti E1, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop, 2010, 114(1): 1-16.
20. Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosis-spreading disease challenging clinicians: a case report and literature review. World J Gastroenterol, 2013, 19(26): 4257-4261.
21. Li FQ, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
22. Bresson-Hadni S, Blagosklonov O, Knapp J, 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(7): 855-865.
23. Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
24. Vuitton DA, Zhang SL, Yang Y, et al. Survival strategy of echinococcus multilocularis in the human host. Parasitol Int, 2006, 55(Suppl): S51-S55.
25. Wang H, Liu Q, Wang Z, et al. Clinical outcomes of ex vivo liver resection and liver autotransplantation for hepatic alveolar echinococcosis. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4): 598-600.
26. Rajesh R, Dalip DS, Anupam J, et al. Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts. Iran J Radiol, 2013, 10(2): 68-73.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Single-Center Experience on Surgical Treatment of Hepatic Echinococcosis

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