Technical challenges in major liver resection for alveolar echinococcosis

Abstract

Background: Alveolar Echinococcosis (AE) is a potentially fatal, often multifocal infection of the liver with malignancy mimicking growth and potential metastasis. Currently the only curative treatment option is radical resection, which is often complicated by parasitic involvement of adjacent organs or hilar structures of the liver. Methods: We retrospectively analyzed the chart of eight patients who underwent major liver resection for EA at our center between '06 and '16. We looked at surgical procedures, post-op complications as well as follow-up. Results: Eight patients (pts) with a mean age of 46y were included. 5/8 pts underwent trisectionectomy (4R/1L) and three a standard hepatectomy (1R/3L). 5 ptshad resection of extra hepatic bile ducts with a complex hepaticojejunostomy in two cases. Two had partial resection and reconstruction (R&R) of the IVC. Two had R&R of the portal vein. One had reconstruction of the right HA. Two had partial R&R of the diaphragm. The median length of hospital stay was 16d Four patients experienced complications >= Dindo 3a. To date all pts are alive, with no signs of recurrent disease and no need of liver transplantation with a mean follow-up of 35 months. Conclusion: Due to its long incubation period patients with EA are often diagnosed late when biliary symptoms arise and the disease is already advanced locally. Yet we believe that resections with complex reconstructions are a feasible alternative to liver transplantation in tertiary centers for HBP surgery.