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Long-term experience on surgical treatment of alveolar echinococcosis

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Abstract

Introduction

Alveolar echinococcosis (AE) is life-threatening and reports on surgical procedures and results are rare, but essential.

Materials and methods

Longitudinal surveillance and long-term follow-up of patients surgically treated for AE during the periods 1982–1999 (group A) and 2000–2006 (group B).

Setting

University hospital within an endemic area.

Results

The median (min–max) follow-up period was 141 (5–417) months. Forty-eight surgical procedures were performed in 36 patients with AE: 63% were partial resections of the liver (additional extrahepatic resection in ten of them), 17% just extrahepatic resections, 10% biliodigestive anastomosis, and 10% exploratory laparotomies. Seventy-five percent of the operations were first-time procedures, 25% done due to a relapse. Forty-two percent of the operations were estimated to be curative (R0), whereas 58% were palliative (R1, R2). All patients had additional medical treatment and periodical follow-up. Two out of 18 (11%) patients, estimated to have had curative surgery, developed a relapse 42 and 54 months later. R0-resection rates depended on the primary, neighboring, metastasis stage of AE (S1, 100%; S2, 100%; S3a, 33%; S3b, 27%; S4, 11%). During the period 2000–2006 elective radical surgery for AE was done only if a safe distance of at least 2 cm was attainable. This concept was associated with an increased R0-resection rate of 87% for group B compared to 24% for group A. Operative procedures done to control complicated courses of AE (jaundice, cholangitis, vascular compression, bacterial superinfection) have not been curative (R2) in 82% because the disease had spread into irresectable structures. Morbidity was 19%. All patients with curative resections are alive. Fifty-six percent of the patients with palliative treatment are alive as long as 14–237 months, 28% died from AE 164–338 months after diagnosis (late lethality), and 17% died due to others diseases 96–417 months after diagnosis of AE. One out of seven (14%) patients suffering from suppurative parasitic necrosis died because it was impossible to control systemic sepsis (3% hospital lethality).

Conclusion

Curative surgery for AE is feasible if the parasitic mass is removable entirely. The earlier the stage, the more frequent is R0 resectability. The observance of a minimal safe distance increases the rate of R0 resections. The benefit of palliative surgery is uncertain due to favorable long-term results of medical treatment alone. However, necrotic tissue is at risk of bacterial superinfection, which can cause life-threatening sepsis. Palliative surgery is an option to treat complications, which could not be managed otherwise.

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Acknowledgment

The authors do very appreciate the comprehensive advice of Professor Dr. R. Muche, Department of Biostatistics, University of Ulm.

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Authors and Affiliations

  1. Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, 89075, Ulm, Germany

    Klaus Buttenschoen, Peter Kern, Hans G. Beger & Doris Henne-Bruns

  2. Division of Infectious Diseases and Clinical Immunology, Internal Medicine, University of Ulm, Ulm, Germany

    Beate Gruener & Stefan Reuter

  3. Department of Anaesthesiology, Donau-Klinik, Neu-Ulm, Germany

    Daniela Carli Buttenschoen

Authors
  1. Klaus Buttenschoen
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  2. Daniela Carli Buttenschoen
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  3. Beate Gruener
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  4. Peter Kern
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  5. Hans G. Beger
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  6. Doris Henne-Bruns
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  7. Stefan Reuter
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Corresponding author

Correspondence to Klaus Buttenschoen.

Additional information

Actual presentation of clinical signs, diagnostics, surgical therapy, trends, and long-term follow-up after surgery for AE.

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Buttenschoen, K., Carli Buttenschoen, D., Gruener, B. et al. Long-term experience on surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg 394, 689–698 (2009). https://doi.org/10.1007/s00423-008-0392-5

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  • DOI: https://doi.org/10.1007/s00423-008-0392-5

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