New classification of alveolar echinococcosis of the liver as a base of new surgical strategy. A multicenter study

Abstract

Aim of study. To improve the results of treatment of patients with hepatic alveolar echinococcosis by developing and introducing into clinical practice a new classification of the disease, which determines the treatment strategy with all available treatment options, including transplant technologies. Material and methods. A total of 323 patients with hepatic alveolar echinococcosis in three high-volume centers with liver transplantation programs were treated by a single protocol and included in the study. Results and discussion. Radical (R0) hepatectomies and liver transplantation were performed in 312 patients. The patients were divided into groups, and the optimal treatment strategy was proposed for each group. In the group of resectable hepatic alveolar echinococcosis there were 79 patients who underwent hepatectomies without vascular reconstruction. In borderline-resectable group there were 168 patients with massive hepatic alveolar echinococcosis with the main liver vessels and (or) the inferior vena cava involvement. Hepatectomies were performed in combination with vascular reconstructions including cases of total vascular exclusion with normo- or hypothermic conservation in vivo or ex vivo . In 65 patients, the lesion was defining as non-resectable. They have hepatic alveolar echinococcosis with critical involvement of the liver parenchyma and (or) with vessels invasion without the possibility of their reconstruction, and (or) cirrhosis of the future liver remnant. The non-alternative method of treatment in this group was liver transplantation. Eleven patients with non-resectable metastases which determined the severity of the condition and made no sense of radical liver surgery were considered incurable. Palliative measures were carried out by such patients. Previously performed non-radical interventions in 43.03% of patients were associated with severe complications (Clavien–Dindo III–V) developed after radical hepatectomies and transplantations. Surgical strategy based on the new classification of hepatic alveolar echinococcosis was effective in 96.6% patients. Conclusion. Routing patients according to the new classification of hepatic alveolar echinococcosis will improve the treatment results by avoiding non-radical surgery associated with the development of complications after further radical surgical treatment.