Liver Resection For Alveolar Echinococcosis Research Articles

The trajectory of anti-recEm18 antibody levels determines follow-up after curative resection of hepatic alveolar echinococcosis

IntroductionRecurrence after curative resection of hepatic alveolar echinococcosis remains a clinical challenge. The current study tested if assessment of anti-recEm18 allows for postsurgical patient surveillance. MethodsA retrospective study with patients undergoing liver resection for alveolar echinococcosis (n = 88) at the University Hospital Bern from 2002 to 2020 and at the University Hospital and Medical Center Ulm from 2011 to 2017 was performed. Analysis was directed to determine a potential association of pre- and postoperative values of anti-recEm18 with clinical outcomes. ResultsAnti-recEm18 had a linear correlation to the maximum lesion diameter (R2 = 0.558). Three trajectories of anti-recEm18 were identified based on a threshold of 10 AU/ml: “Em18-low” (n = 31), “responders” (n = 53) and “residual disease” (n = 4). The decline of anti-recEm18 in “responders” reached a plateau after 10.9 months at which levels decreased by 90%. The only patient with recurrence in the entire population was also the only patient with a secondary increase of anti-recEm18. ConclusionIn patients with preoperative elevated values, anti-recEm18 confirms curative surgery at 12 months follow-up and allows for long-term surveillance.

Significance of the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Preoperative Nutritional Index as Predictors of Morbidity in Patients Who Underwent Liver Resection for Alveolar Echinococcosis.

We aimed to evaluate the significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and preoperative nutritional index (PNI) as predictors of morbidity in patients who underwent liver resection for alveolar echinococcosis. This single-center study was designed as a retrospective study after obtaining ethical committee approval. The files of patients hospitalized at Ataturk University Faculty of Medicine, Erzurum, Turkey, between 2010 and 2019 and who underwent resection or liver transplantation for liver alveolar cysts were reviewed. Demographic features, laboratory parameters (complete blood count and biochemical parameters), lesion localizations and characteristics, type of surgery, intraoperative and postoperative complications (morbidity), and mortality status were evaluated by scanning patients' files. Preoperative blood samples were taken the day before the surgery, which is the period farthest from surgical stress, to have more accurate results. By contrast, postoperative blood samples were taken on the first postoperative daywhen surgical stress was the highest. The differences between the morbidity groups, including NLR, PLR, and PNI, were compared. Of the 172 patients in the study, 96 (55.8%) were female. The mean age of all patients was 48.51±15.57 (18-90). Perioperative complications were seen in 30 (17.4%) patients, while the morbidity and mortality rates of the study were 28.5% and 19.2%, respectively. Age, gender of patients, and preoperative laboratory parameters, including NLR, PLR, and PNI, did not affect morbidity. However, the presence of perioperative vascular injury (P=0.040) and complications (P=0.047), low postoperative lymphocyte rates (P=0.038), and high postoperative NLR were associated with increased morbidity. In addition, the mortality rate was significantly increased in patients with morbidity (P<0.001). From the results of the present study, it was found that preoperative parameters did not affect morbidity, while increased postoperative NLR levels and decreased lymphocyte rates increased morbidity.

Anti-Recem18 Antibody Levels are Associated with Lesion Size and Determine Follow-Up after Resection of Hepatic Alveolar Echinococcosis

Abstract Background Best monitoring practices for patients after resection of hepatic alveolar echinococcosis remain unclear. Aims The current study tested if assessment of anti-recEm18 allows for postsurgical patient surveillance. Methods A retrospective study with patients undergoing liver resection for alveolar echinococcosis at the University Hospital Berne from December 2002 to December 2020 and at the University Hospital and Medical Center Ulm from January 2011 to December 2017 was performed. Analysis was directed to determine a potential association of pre- and postoperative values of anti-recEm18 with clinical outcomes. Results Among 147 patients who underwent liver resection for alveolar echinococcosis in curative intent, perioperative results of recEm18-serology were available in 88 patients. In patients without residual disease, the postoperative anti-recEm18 value after 12 months dropped to a mean of 2 AU/ml (standard deviation: 4 AU/ml). Three trajectories of anti-recEm18 were identified based on a threshold of 10 AU/ml: “Em18-low” (n = 31, 35%) with anti-recEm18 values below 10 AU/ml pre- and postoperatively, “responders” (n = 53, 60%) with preoperative values above 10 AU/ml and a postoperative decrease of more than 80% of the initial anti-recEm18 and “residual disease” (n = 4, 5%) with the postoperative presence of residual disease. The decline of anti-recEm18 in “responders” reached a plateau after 11.4 months at which levels decreased by 80%. The only recurrence in the entire population was identified by a secondary increase of anti-recEm18. Anti-recEm18 levels had a linear correlation to the maximum lesion diameter (R2 = 0.558). Conclusions Anti-recEm18 antibody levels correlate with the lesion size preoperatively and response to surgery postoperatively. Anti-recEm18 allows to be applied as serological surveillance marker during postoperative follow-up in patients with elevated preoperative anti-recEm18 levels.

Radical and nonradical hepatic resection for alveolar echinococcosis: Report of 18 cases

The authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external-internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with "en bloc" extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow-up. The 9 patients treated by radical resection are alive and symptom-free and appear to be disease-free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow-up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow-up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.