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09.05.2019 | original article Open Access

Exploring the limits of hepatic surgery for alveolar echinococcosis—10-years’ experience in an endemic area of Austria

Zeitschrift:
European Surgery
Autoren:
Stefanie Kuscher, Irmgard Elisabeth Kronberger, Alexander Loizides, Michaela Plaikner, Marijana Ninkovic, Andrea Brunner, Herbert Auer, Eva Maria Gassner, Dietmar Öfner, Stefan Schneeberger
Wichtige Hinweise
The authors Stefanie Kuscher and Irmgard Elisabeth Kronberger contributed equally to the manuscript.

Publisher’s Note

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Summary

Background

Hepatic alveolar echinococcosis is a slow-growing, destructive parasitosis for which radical surgical resection is currently the only curative treatment. In case of complications by infiltrated vascular or biliary structures, interventional techniques are used. Pharmacotherapy is recommended postoperatively and for inoperability. The rare zoonotic occurs in the northern hemisphere and still poses a challenge in diagnostic and therapeutic management. Based in an endemic area in Austria, we evaluated a decade of surgical treatment for alveolar echinococcosis (AE) at our department.

Methods

Clinical data of patients undergoing hepatic resection for AE at our department between 2005 and 2014 were collected. Every diagnosis was again verified by histology and PCR. The PNM staging of preoperative imaging was done in six-eye principle. This study was approved by the local Ethics Committee of the Medical University Innsbruck (registration number 20170307-1537).

Results

Nine of 12 patients had an R0 resection. In one case, cure was achieved by a combination of surgery and radiofrequency ablation, one patient had R2 resection due to unexpected AE spread and another patient underwent salvage operation with lethal outcome. Three patients experienced early postoperative complications. Late postoperative complications included incisional hernia and cholestatic hepatopathy. 9 patients have been disease free for a mean period of 6 years.

Conclusion

The relevance and perioperative risks of an extensive AE resection and avoidance of R2 resections are reflected in the present study. Determination of PNM stage and evaluation of in-all resectability build the foundation for successful surgical treatment even in an advanced AE stage.

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