Abstract
Background
The World Health Organization guidelines recommend radical hepatic resection for definite treatment of alveolar echinococcosis (AE), because it can cure the patient. However, parasitic masses are not entirely removable in about 70% of patients. Even so, palliative resections are carried out, although cure cannot be achieved. As conservative treatment has improved, the role of palliative surgical procedures has to be redefined.
Methods
Critical appraisal of published reports on palliative resections for AE and estimation of the level of evidence and grade of recommendation.
Results
Prospective randomized trials comparing palliative resections, radical resections, and conservative treatment are lacking. Most papers analyzed case series retrospectively. The number of palliative operations is significant. In the past, palliative resections were recommended in order to enhance anthelminthic drug efficacy but advances in conservative and interventional treatment improved the prognosis of AE. Prolonged survival by systematic palliative resections is not evident. However, palliative surgery is an option to treat persistent bacterial infection, fistulas, and obstructing or compressing masses. The indication is based on individual considerations and decisions.
Conclusion
Curative surgery for AE is feasible if parasitic tissue is entirely removable. The benefit of palliative resections is uncertain because long-term results of conservative treatment are favorable. Palliative surgery is an option for complications not being manageable otherwise.
Similar content being viewed by others
References
Mosimann F (1980) Is alveolar hydatid disease of the liver incurable. Ann Surg 192:118–123 doi:10.1097/00000658-198007000-00021
Ishizu H, Uchino J, Sato N, Aoki S, Suzuki K, Kuribayashi H (1997) Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery. Hepatology 25:528–531 doi:10.1002/hep.510250305
Wilson JF, Rausch RL, McMahon BJ, Schantz PM (1992) Parasiticidal effect of chemotherapy in alveolar hydatid disease. Review of experience with mebendazole and albendazole in Alaskan Eskimos. Clin Infect Dis 15:234–249
Ammann RW, Eckert J (1996) Cestodes; Echinococcus. Gastroenterol Clin North Am 25:655–689 doi:10.1016/S0889-8553(05)70268-5
Thompson RCA, Lymbery AJ (1995) Echinococcus and hydatid disease. CABI, Wallingford
Bresson-Hadni S, Vuitton DA, Bartholomot B, Heyd B, Godart D, Meyer JP et al (2000) A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol 12:327–336
PUBMED (2007) [database online]. A Service of the National Library of Medicine and the Institutes of Health. http://www.pubmed.gov
WHO Informal Working Group on Echinococcosis (1996) Guidelines for treatment of cystic and alveolar echinococcosis in humans. Bull World Health Organ 74:231–242
Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336 doi:10.1136/bmj.323.7308.334
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490 doi:10.1136/bmj.328.7454.1490
Bengisun U, Tunc G, Kesenci M, Kuzu I, Demirci S, Alic B (1997) Surgical treatment of advanced alveolar hydatid disease of the liver: a report of five cases. Surg Today 27:261–265 doi:10.1007/BF00941658
Senturk H, Mert A, Ersavasti G, Tabak F, Akdogan M, Ulualp K (1998) Bronchobiliary fistula due to alveolar hydatid disease: report of three cases. Am J Gastroenterol 93:2248–2253
Sato N, Uchino J, Takahashi M, Aoki S, Takahashi H, Yamashita K et al (1997) Surgery and outcome of alveolar echinococcosis of the liver: historical comparison of mass screening systems in Japan. Int Surg 82:201–204
Polat KY, Balik AA, Celebi F (2002) Hepatic alveolar echinococcosis: clinical report from an endemic region. Can J Surg 45:415–419
Kadry Z, Attigah N, Furrer K, Renner E, Ammann R, Clavien PA (2003) 94—Surgical is better than conservative therapy in alveolar echinococcosis: long term follow-up in 90 consecutive patients. J Gastrointest Surg 7:287 doi:10.1016/S1091-255X(02)00296-2
Huang J, Wu YM, Liang PC, Lee PH (2004) Alveolar hydatid disease causing total occlusion of the inferior vena cava. J Formos Med Assoc 103:633–636
Kadry Z, Renner EC, Bachmann LM, Attigah N, Renner EL, Ammann RW et al (2005) Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg 92:1110–1116 doi:10.1002/bjs.4998
Jiang C (1998) Alveolar echinococcosis in China. Chin Med J (Engl) 111:470–475
Sato N, Namieno T, Furuya K, Takahashi H, Yamashita K, Uchino J et al (1997) Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis. J Gastroenterol 32:351–354
Bresson-Hadni S, Delabrousse E, Blagosklonov O, Bartholomot B, Koch S, Miguet JP et al (2006) Imaging aspects and non-surgical interventional treatment in human alveolar echinococcosis. Parasitol Int 55(Suppl):S267–S272 doi:10.1016/j.parint.2005.11.053
Bresson-Hadni S, Humbert P, Paintaud G, Auer H, Lenys D, Laurent R et al (1996) Skin localization of alveolar echinococcosis of the liver. J Am Acad Dermatol 34:873–877 doi:10.1016/S0190-9622(96)90068-7
Ambo M, Adachi K, Ohkawara A (1999) Postoperative alveolar hydatid disease with cutaneous–subcutaneous involvement. J Dermatol 26:343–347
Reuter S, Buck A, Grebe O, Nussle-Kugele K, Kern P, Manfras BJ (2003) Salvage treatment with amphotericin B in progressive human alveolar echinococcosis. Antimicrob Agents Chemother 47:3586–3591 doi:10.1128/AAC.47.11.3586-3591.2003
Uchino J, Sato N, Nakajima Y, Matsushita M, Takahashi M, Une Y (1993) XI. Treatment. In: Uchino J, Sato N (eds) Alveolar echinococcosis of the liver. Hokkaido University School of Medicine, Sapporo, pp 137–149
Wilson JF, Rausch RL, Wilson FR (1995) Alveolar hydatid disease. Review of the surgical experience in 42 cases of active disease among Alaskan Eskimos. Ann Surg 221:315–323 doi:10.1097/00000658-199503000-00015
Buttenschoen K, Schorcht P, Reuter S, Carli Buttenschoen D, Kern P, Beger HG (2001) Die chirurgische Therapie der alveolären Echinokokkose und deren Langzeitergebnisse. Chirurg 72:566–572 doi:10.1007/s001040170136
Reuter S, Jensen B, Buttenschoen K, Kratzer W, Kern P (2000) Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. JAC 46:451–456
WHO/OIE (2001) Manual on Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern. World Organisation for Animal Health and World Health Organisation, Paris, France
Acknowledgement
The first author presented parts of the manuscript during an invited lecture at the ‘WHO Informal Working Group on Echinococcosis “Updating the WHO–IWGE Guidelines” Meeting’, Besançon/Saline Royale d’Arc-et-Senans, France, September 28–30, 2007.
Author information
Authors and Affiliations
Corresponding author
Additional information
Study aim Evaluation of the role of palliative operation for AE.
Rights and permissions
About this article
Cite this article
Buttenschoen, K., Gruener, B., Carli Buttenschoen, D. et al. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch Surg 394, 199–204 (2009). https://doi.org/10.1007/s00423-008-0367-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0367-6