Alveolar Echinococcosis-A Challenging Task for the Hepatobiliary Surgeon.

Jens Strohaeker,Silvio Nadalin,Mihaly Sulyok,Alfred Koenigsrainer

doi:10.3390/pathogens11010040

Abstract

(1) Background: Alveolar echinococcosis (AE) is an ultimately fatal disease, whose only curative treatment is surgery. Due to its late presentation extended liver resections are often necessary. The true benefit of extensive surgery has yet to be established; (2) Methods: We present a single center experience of 33 cases of Echinococcus multilocularis that have been treated at a high-volume hepatobiliary surgery center between 2004 and 2021. (3) Results: Of the 33 patients 24 patients underwent major liver resection (73%). In addition to the liver resection patients frequently underwent complex extrahepatic procedures such as lymphadenectomy (n = 21, 61%), vascular resections and reconstructions (n = 9, 27%) or resections and reconstruction of the extrahepatic bile duct (n = 11, 33%). Seven patients suffered from ≥ grade III complications (21%). Complete resection was achieved in 17 patients. Fourteen patients had R1 resections and two had macroscopic parasitic remnant (R2). Progressive disease was reported in three patients (The two R2 patients and one R1 resected patient). At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE. Even in extensive disease the combination of complex resection and perioperative benzimidazoles can achieve favorable long-term outcomes.

Highlights

Alveolar echinococcosis (AE) is a rare parasitic infection caused by E. multilocularis that mainly affects central and eastern Europe, parts of Turkey, and Western Asia [1].The most commonly infected organ is the liver from where the parasites spreads via the hematogenous route or continuous infiltration
At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE
The main aim of this study is to present our results with liver resection in a German endemic area of AE

Summary

Introduction

Alveolar echinococcosis (AE) is a rare parasitic infection caused by E. multilocularis that mainly affects central and eastern Europe, parts of Turkey, and Western Asia [1]. The most commonly infected organ is the liver from where the parasites spreads via the hematogenous route or continuous infiltration. Left untreated it is fatal in up to 90% of patients over 10 years [2,3,4]. The zoonosis has been treated surgically until the benzimidazoles (BMZ) were introduced as parasitostatic treatment alternatives in the. While the only cure of the disease is complete resection (followed by adjuvant medical therapy) the beneficial outcomes of “palliative” medical treatment has become the main alternative to surgery predominantly in patients of advanced age and disease. The introduction of BMZ has lifted the 10-year survival rate from around

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