Challenges, Prognosis and Outcomes of Surgical Resection for Hepatic Alveolar Echinococcosis: A Single Centre Experience

Year 2017, Volume: 44 Issue: 2, 183 - 190, 07.06.2017

Ahmet Rencuzogulları , Ismail Soner Koltas Atilgan Tolga Akcam Abdullah Ulku Orcun Yalav Ahmet Gokhan Saritas Kubilay Dalcı Ismail Cem Eray

https://doi.org/10.5798/dicletip.319757

Abstract

Objective: Alveolar echinococcosis (AE) is an aggressive and potentially fatal infection, which affects the liver
primarily and presents as a tumor-like lesion. Outcomes associated with surgical procedures for this infection have
been rarely reported. In the present study, we aimed to evaluate long-term surgical treatment outcomes associated
with hepatic AE.
Methods: Between 2001 and 2013, the management and outcomes of twelve consecutive hepatic AE patients who
were considered feasible for complete hepatic resection with/without metastasectomy were described. In all patients,
pre-operative diagnosis of AE was based on clinical findings, imaging studies, and serological tests. Antibodies against
antigens of Echinococcus multilocularis metacestodes were screened as specific markers for the serological diagnosis
of AE by Western blot. The oral albendazole protocol was administered for hepatic AE patients who had complete
resection.
Results: Twelve patients (F/M=7/5) underwent complete resection for pathologically confirmed hepatic AE during
the study period. Median follow-up was 82 (32-164) months. The most common initial symptom was abdominal pain
(n=9) followed by jaundice (n=4). Four patients had metastasis: Brain, surrenal, splenic and colon. One patient was
lost due to massive pulmonary emboli despite appropriate interventions. All other complications that emerged were
treated successfully.
Conclusion: Long-term favorable outcomes can be achieved by complete surgical resection followed by
chemotherapy with albendazole in advanced hepatic AE cases.

Keywords

alveolar echinococcosis; hepatic resection; Echinococcus multilocularis

References

• 1. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis. 2003; 16:437-44.
• 2. Miman O, Yazar S. Alveolar echinococcosis in Turkey:In the light of the literature.Turkiye Parazitol Derg.2012; 36: 116-20.
• 3. Atanasov G, Benckert C, Thelen A, et al. Alveolar echinococcosis-spreading disease challenging clinicians: A case report and literature review.World J Gastroenterol. 2013; 19: 4257-61.
• 4. Buttenschoen K, Kern P, Reuter S, et al. Hepatic infestation of Echinococcus multilocularis with extension to regional lymph nodes. Langenbecks Arch Surg. 2009; 394: 699–704.
• 5. Ishizu H, Uchino J, Sato N, et al. Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery. Hepatology. 1997; 25: 528–31.
• 6. Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am. 1996; 25: 655–89.
• 7. Rutkauskas S, Gedrimas V, Pundzius J, et al. Clinical and anatomical basis for the classification of the structural parts of liver. Medicina (Kaunas). 2006; 42: 98-106.
• 8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205–13.
• 9. Craig PS, Deshan L, MacPherson CN, et al. A large focus of alveolar echinococcosis in central China. Lancet. 1992; 340: 826–31.
• 10. Moro P, Schantz PM. Echinococcosis: a review. Int J Infect Dis. 2009; 13: 125–33.
• 11. Kawamura N, Kamiyama T, Sato N, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg. 2011 May; 212: 804-12
• 12. Tiaoying L, Jiamin Q, Wen Y, et al. Echinococcosis in Tibetan populations, western Sichuan Province, China. Emerg Infect Dis. 2005; 11:1866-73.
• 13. Czermak BV, Akhan O, Hiemetzberger R, et al. Echinococcosis of the liver. Abdom Imaging. 2008; 33:133–143.
• 14. Maier W. Computed tomographic diagnosis of Echinococcus alveolaris. Hepatogastroenterology. 1983; 30:83–5.
• 15. Hatipoglu S, Bulbuloglu B, Piskin T, et al. Living donor liver transplantation for alveolar echinococcus is a difficult procedure. Transplant Proc. 2013; 45:1028-30.
• 16. Moray G, Shahbazov R, Sevmis S, et al. Liver transplantation in management of alveolar echinococcosis: two case reports. Transplant Proc. 2009; 41: 2936-8.
• 17. Ayifuhan A, Tuerganaili A, Jun C, et al. Surgical treatment for hepatic alveolar echinococcosis: report of 50 cases. Hepatogastroenterology. 2012; 59: 790-3.
• 18. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010; 114:1-16.
• 19. Brunetti E, Maiocchi L, Garlaschelli AL, et al. Overview of therapeutic options for cystic echinococcosis. Parassitologia. 2004; 46:53-5.
• 20. McManus DP, Li Z, Yang S, et al. Case studies emphasizing the difficulties in the diagnosis and management of alveolar echinococcosis in rural China. Parasit Vectors. 2011; 4:196.
• 21. Kern P. Clinical features and treatment of alveolar echinococcosis. Curr Opin Infect Dis. 2010; 23:505–12.
• 22. Ozdemir NG, Kurt A, Binici DN, et al. Echinococcus alveolaris: presenting as a cerebral metastasis. Turk Neurosurg. 2012; 22: 448-51.
• 23. Algros MP, Majo F, Bresson-Hadni S, et al.Intracerebral alveolar echinococcosis. Infection. 2003;31: 63-5.