Results of Surgical Treatment of Patients with Liver Alveolar Echinococcosis

Abstract

Aim . To evaluate surgical outcomes in patients with liver alveococcosis. Material and Methods. 581 patients have been included for the period 2000–2016. There were 366 (62.9%) women and 215 (37.1%) men. Mean age was 35.0 ± 1.5 years. Right liver lobe lesion was observed in 380 (65.4%) cases, left lobe involvement – in 140 (24.1%) cases, both lobes lesion – in 61 (10.5%) patients. 8 patients had lungs metastases, 3 – brain metastases, 1 – metastases in right ventricle and lungs. One patient had a rare coinfection of alveococcosis with echinococcosis. 570 patients underwent surgery. Results. Radical surgery was performed in 424 (74.3%) cases, palliative procedures – in 146 (25.5%) patients. 163 (28.1%) patients underwent right-sided hemihepatectomy including tangential inferior vena cava resection in 3 patients. Advanced right- sided hemihepatectomy was carried out in 36 (6.2%) cases including 2 cases of concomitant tangential resection of inferior vena cava and 4 cases of common bile duct resection followed by hepaticojejunostomy. Left-sided hemihepatectomy was made in 95 (16.4%) patients, 2 of them underwent concomitant tangential resection of inferior vena cava. Advanced left-sided hemihepatectomy was performed in 22 (3.6%) cases including tangential resection of portal vein in 1 patient and common bile duct resection followed by hepaticojejunostomy in 1 patient. Atypical or anatomic liver resection (segmentectomy, double segmentectomy, triple segmentectomy) was made in 64 (11.1%) patients. Hemihepatectomy followed by resection of the other lobe was carried out in 44 (7.5%) cases. Percutaneous transhepatic cholangiostomy was made in 28 (4,8%) cases, explorative laparotomy – in 25 (4.3%) patients. Transhepatic drainage of bile ducts was performed in 42 (7.2%) cases, cytoreductive procedures – in 51 (8.8%) cases. Postoperative morbidity rate was 9.8% (n = 56), mortality – 2.1% (n = 12). Conclusion. Radical surgery for liver alveococcosis is difficult but provides positive results in timely diagnosis. Proportion of radical procedures is much greater in case of early diagnosis of the disease. Palliative surgery combined with chemotherapy with albendazole is justified to improve quality of life.