Challenges, Prognosis and Outcomes of Surgical Resection for Hepatic Alveolar Echinococcosis: A Single Centre Experience

Abstract

Objective: Alveolar echinococcosis (AE) is an aggressive and potentially fatal infection, which affects the liver primarily and presents as a tumor-like lesion. Outcomes associated with surgical procedures for this infection have been rarely reported. In the present study, we aimed to evaluate long-term surgical treatment outcomes associated with hepatic AE. Methods: Between 2001 and 2013, the management and outcomes of twelve consecutive hepatic AE patients who were considered feasible for complete hepatic resection with/without metastasectomy were described. In all patients, pre-operative diagnosis of AE was based on clinical findings, imaging studies, and serological tests. Antibodies against antigens of Echinococcus multilocularis metacestodes were screened as specific markers for the serological diagnosis of AE by Western blot. The oral albendazole protocol was administered for hepatic AE patients who had complete resection. Results: Twelve patients (F/M=7/5) underwent complete resection for pathologically confirmed hepatic AE during the study period. Median follow-up was 82 (32-164) months. The most common initial symptom was abdominal pain (n=9) followed by jaundice (n=4). Four patients had metastasis: Brain, surrenal, splenic and colon. One patient was lost due to massive pulmonary emboli despite appropriate interventions. All other complications that emerged were treated successfully. Conclusion: Long-term favorable outcomes can be achieved by complete surgical resection followed by chemotherapy with albendazole in advanced hepatic AE cases.