Preoperative percutaneous drainage of the cystic cavity facilitates resectability in hepatic alveolar echinococcosis

Abstract

Background: HAE is a parasitic disease. The dense pericystic inflammation caused by this disease makes resection difficult even impossible. The cystic cavity is full with necrotic material and sometimes infected bile or even an abscess. We hypothesised that drainage of the cystic contents can reduce inflammation and facilitate surgery Methods: We retrospectively evaluated our records of HAE cases. Records of patients who had unresectable liver masses at the first diagnosis and further underwent preoperative percutaneous drainage with a subsequent liver resection, were evaluated. All demographic, radiological and clinical data were collected. Results: Between January 2000 and December 2016 237 HAE cases were followed in our clinic. From these 151 had unresectable liver mass at the first diagnosis. Among these patients with unresectable disease 25 had solitary lesions with a cystic cavity. These 25 patients underwent a preoperative percutaneous drainage and re-evaluated for resection and 15 patients underwent a curative resection. The resectability rate was 36.2% at the first evaluation and 42,6% after the drainage. The remaining 10 patients referred for medical treatment. One denied further treatment, three were transplanted and six are still at medical treatment. Conclusion: Preoperative percutaneous drainage of the solitary cystic cavity reduces pericystic inflammation and facilitates resection. Decision for resectability could be made after percutaneous drainage in patients with solitary lesions with cystic cavity.