Results of Surgical Treatment of Patients with Liver Alveolar Echinococcosis

Aim. To evaluate surgical outcomes in patients with liver alveococcosis.

Material and Methods. 581 patients have been included for the period 2000–2016. There were 366 (62.9%) women and 215  (37.1%) men. Mean age was 35.0 ± 1.5 years. Right liver lobe  lesion was observed in 380 (65.4%) cases, left lobe involvement – in 140 (24.1%) cases, both lobes lesion – in 61 (10.5%) patients. 8  patients had lungs metastases, 3 – brain metastases, 1 –  metastases in right ventricle and lungs. One patient had a rare  coinfection of alveococcosis with echinococcosis. 570 patients underwent surgery.

Results. Radical surgery was performed in 424 (74.3%) cases, palliative procedures – in 146 (25.5%) patients. 163 (28.1%)  patients underwent right-sided hemihepatectomy including  tangential inferior vena cava resection in 3 patients. Advanced right- sided hemihepatectomy was carried out in 36 (6.2%) cases including 2 cases of concomitant tangential resection of inferior vena cava and 4 cases of common bile duct resection followed by  hepaticojejunostomy.  Left-sided hemihepatectomy was made in 95  (16.4%) patients, 2 of them underwent concomitant tangential  resection of inferior vena cava. Advanced left-sided hemihepatectomy was performed in 22 (3.6%) cases including tangential resection of portal vein in 1 patient and common bile duct  resection followed by hepaticojejunostomy in 1 patient. Atypical or  anatomic liver resection (segmentectomy, double segmentectomy,  triple segmentectomy) was made in 64 (11.1%) patients. Hemihepatectomy followed by resection of the other lobe was carried out in 44 (7.5%) cases. Percutaneous transhepatic cholangiostomy  was made in 28 (4,8%) cases, explorative laparotomy – in 25  (4.3%) patients. Transhepatic drainage of bile ducts was performed  in 42 (7.2%) cases, cytoreductive procedures – in 51 (8.8%) cases. Postoperative morbidity rate was 9.8% (n = 56), mortality – 2.1% (n = 12).

Conclusion. Radical surgery for liver alveococcosis is difficult but provides positive results in timely diagnosis. Proportion of radical  procedures is much greater in case of early diagnosis of the disease.  Palliative surgery combined with chemotherapy with albendazole is justified to improve quality of life.

1. Alperovich B.I., Potapov A.V., Salo V.N. Liver cryosurgery in experiment and clinic. Bjulleten sibirskoj mediciny. 2003; 3: 56–60. (In Russian)

2. Karaeva R.R., Torgerson R.P. Epizootological and epidemiological situation of echinococcosis in a comparative aspect in the periods before and after the adoption of the sovereignty of the Kyrgyz Republic. Zdravoohranenije Kyrgyzstana. 2006; 3: 11–15. (In Russian)

3. Rayimkulov K.M., Karaeva R.R., Aitbaev S.A. Multichambered echinococcosis in northern Kyrgyzstan and the causes of invasion. Zdravoohranenije Kyrgyzstana. 2006; 2: 43–49. (In Russian)

4. Sejsembajev M.A., Bajmahanov B.B., Ramazanov M.E. The choice of radical surgery for liver alveococcosis. Almanah Instituta khirurgii im. A.V. Vishnevskogo. 2011; 6 (2): 114. (In Russian)

5. Stettler M., Rossigmol Y.F., Fink R. Secondary and primary murine alveolar echinococcosis: combined albendazolenitazoxanide chemotherapy exhibits profound antiparasitic activity. Int. Y. Parasitol. 2004; 34 (5): 615–624.

6. Zagainov V.E., Kiselev N.M., Gorokhov G.G. Modern methods of surgical treatment of diffuse liver alveococcosis. Annaly khirurgicheskoj gepatologii = Annals of HPB surgery. 2016; 21 (1): 44–52. (In Russian) DOI: 10.16931/1995-5464.2016144-52.

7. Bebezov B.H., Umetaliev T.M., Mamashev N.D., Surov E.A., Esenkulov Ch.T. Surgery for liver alveococcosis with lesion of inferior vena cava and portal vein. Vestnik Kirgiskogo-Rossiiskogo Slavynskogo Universiteta. 2015; 15 (7): 27–30. (In Russian)

8. Galperin E.I. Liver regeneration after advanced resections and lesions (experimental study). Annaly khirurgicheskoj gepatologii = Annals of HPB surgery. 2002; 7 (1): 279–283. (In Russian)

9. Li H., Song T., Shao Y., Wen H. Chemotherapy in alveolar echinococcosis of multi- organs: what’s the role? Parasitol. Res. 2013; 112 (6): 2237–2243. DOI: 10.1007/s00436-013-3382-7.

10. Porshennikov I.A. Right-sided liver resection techniques for advanced alveolar echinococcosis with vascular invasion. Sovremennye tehnologii v medicine. 2017; 9 (1): 44–55. (In Russian)

11. Voskanyan S.E., Artemiev A.I., Naydenov E.V., Zabezhinsky D.A., Chuchuev E.S., Rudakov V.S., Shabalin M.V., Shcherbin V.V. Transplantation technologies for surgical treatment of locally advanced hepatic alveococcosis with invasion into great vessels. Annaly khirurgicheskoj gepatologii = Annals of HPB surgery. 2016; 21 (2): 25–31. (In Russian) DOI: 10.16931/1995-5464.2016225-31.