Surgical treatment of liver alveococcosis

Aim. To improve the results of diagnosis and surgical treatment of liver alveococcosis.

Material and methods. There were 415 patients with liver alveococcosis for the period 2009–2018. Liver resection was performed in 364 patients. Metastases in the brain were detected in 7 patients, lungs – in 3 cases, soft tissues involvement – in another 3 ones. Hepatic-bronchial fistula occurred in 2 cases. Mean age of patients was 41 ± 2.3 years. There were 128 (30.8%) men and 287 (69.2%) women.

Results. Advanced liver resection was performed in 187 patients, atypical resection – in 177 cases. R0-resection was carried out in 62.4% of cases, R1–2 procedures – in 37.6%, diagnostic laparotomy – in 4.4%. Four patients died in early postoperative period.

Conclusion. The final decision about resectability may be made after intraoperative assessment, intraoperative ultrasound, Doppler sonography and liver mobilization. Liver resection for advanced alveococcosis is extensive, needs for resection and replacement of great vessels, as well as bile ducts repair. Radical treatment is R0-resection if distant metastases are absent. Redo surgery is advisable for liver alveococcosis.

1. Kawamura N., Kamiyama T., Sato N., Nakanishi K., Yokoo H., Kamachi H., Tahara M., Yamaga S., Matsushita M., Todo S. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J. Am. Coll. Surg. 2011; 212 (5): 804–812. http://doi.org/10.1016/j.jamcollsurg.2011.02.007

2. Kern P., Menezes da Silva A., Akhan O., Müllhaupt B., Vizcaychipi K.A., Budke C., Vuitton D.A. The echinococcoses: diagnosis, clinical management and burden of disease. Adv. Parasitol. 2017; 96: 259–369. http://doi.org/10.1016/bs.apar.2016.09.006

3. Skipenko O.G., Shatveryan G.A., Bagmet N.N., Chekunov D.A., Bedzhanyan A.L., Ratnikova N.P., Zavoykin V.D. Liver alveococcosis: a retrospective analysis of the treatment of 51 patients. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal imeni N.I. Pirogova. 2012; 12: 4–13. (In Russian)

4. WHO Informal Working Group on Echinococcosis. Guidelines for treatment of cystic and alveolar echinococcosis in humans. Bull. World Health Organ. 1996; 74 (3): 231–242. PMCID: PMC2486920

5. Torgerson P.R., Schweiger A., Deplazes P., Pohar M., Reichen J., Ammann R.W., Tarr P.E., Halkik N., Müllhaupt B. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J. Hepatol. 2008; 49 (1): 72–77. http://doi.org/10.1016/j.jhep.2008.03.023

6. Craig P.S. Echinococcosis Working Group in China. Epidemiology of human alveolar echinococcosis in China. Parasitol. Int. 2006; 55 (Suppl.): S221–225. http://doi.org/10.1016/j.parint.2005.11.034

7. Torgerson P.R. The emergence of echinococcosis in central Asia. Parasitology. 2013; 140 (13): 1667–1673. http://doi.org/10.1017/S0031182013000516

8. Kriokhirurgicheskiye operatsii pri zabolevaniyakh pecheni i podzheludochnoy zhelezy [Cryosurgery for liver and pancreatic diseases]. Pod red. prof. B.I. Al'perovicha. Moscow: GEOTARMedia, 2015. 240 p. (In Russian)

9. Stepanova Yu.A., Ionkin D.A., Ashivkina O.I., Zhavoronkova O.I., Chzhao A.V., Vishnevsky V.A. Liver alveococcosis: the possibilities of ultrasound at the stages of combined surgical treatment. Doktor.Ru. Gastroenterologiya. 2016; 118 (1): 74–79. (In Russian)

10. Ziadinov I., Deplazes P., Mathis A., Mutunova B., Abdykerimov K., Nurgaziev R., Torgerson P.R. Frequency distribution of Echinococcus multilocularis and other helminths of foxes in Kyrgyzstan. Vet. Parasitol. 2010; 171 (3–4): 286–292. http://doi.org/10.1016/j.vetpar.2010.04.006

11. Usubalieva J., Minbaeva G., Ziadinov I., Deplazes P., Torgerson P.R. Human alveolar echinococcosis in Kyrgyzstan. Emerg. Infect. Dis. 2013; 19 (7): 1095–1097. http://doi.org/10.3201/eid1907.121405

12. Bebezov B., Mamashev N., Umetaliev T., Ziadinov I., Craig P.S., Joekel D.E., Torgerson P.R. Intense focus of alveolar echinococcosis, South Kyrgyzstan. Emerg. Infect. Dis. 2018; 24 (6): 1119–1122. https://doi.org/10.3201/eid2406.161641

13. Bebezov Kh.S., Bebezov B.Kh., Mamashev N.D., Umetaliev T.M., Belekbaev T.M. Surgical treatment of complicated forms of liver alveococcosis. Vestnik KazNMU. 2012; 4: 49–50. (In Russian)

14. Zhuravlev V.A., Rusinov V.M., Sukhorukov V.P., Buldakov V.V., Popyrin I.A., Yuzhanin V.B. Radikal'noye lecheniye al'veokokkoza s vovlecheniyem magistal'nykh sosudov i nizhney poloy veny [Radical treatment of alveococcosis involving great vessels and inferior vena cava]. Collection of materials of the XVII International Congress of Surgeons and Hepatologists of Russia and the CIS countries. Ufa, 2010, 263–264. http://hepatoassociation.ru/congress/work (In Russian)

15. Bebezov Kh.S., Bebezov B.Kh., Mamashev N.D., Bularkiyev A.B., Umetaliyev T.M., Turkbayev A.B. Advanced liver resection by the portal method. Zdravookhraneniye Kyrgyzstana. 2010; 1: 11–33. (In Russian) http://www.zdrav.kg/ uploads/archive_file/9a4b431595da051e31a496cbc1a948a1.pdf

16. Kern P., Bardonnet K., Renner E., Auer H., Pawlowski Z., Ammann R.W., Vuitton D.A. European echinococcosis registry: human alveolar echinococcosis, Europe, 1982–2000. Emerg. Infect. Dis. 2003; 9 (3): 343–349. http://doi.org/10.3201/eid0903.020341

17. Zagaynov V.E., Kiselev N.M., Gorokhov G.G., Vasenin S.A., Belskiy V.A., Shalapuda V.I., Rykhtik P.I. Modern methods of surgical treatment of diffuse liver alveococcosis. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2016; 21 (1): 44–52. https://doi.org/10.16931/1995-5464.2016144-52 (In Russian)

18. 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 liver alveococcosis with great vessels invasion. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2016; 21 (2): 25–31. https://doi.org/10.16931/1995-5464.2016225-31. (In Russian)

19. Porshennikov I.A. Right-sided liver resection techniques for alveolar echinococcosis with vascular invasion. Sovremennye tekhnologii v medicine. 2017; 9 (1): 44–55. http://doi.org/10.17691/stm2017.9.1.05 (In Russian)

20. Buttenschoen K., Gruener B., Buttenschoen D.C., Reuter S., Henne-Bruns D., Kern P. Palliative operation for the treatment of alveolar echinococcosis. Langenbecks Arch. Surg. 2009; 394 (1): 199–204. http://doi.org/10.1007/s00423-008-0367-6.

21. Alperovich B.I., Merzlikin N.V., Salo V.N., Zaytsev I.S. Rol' i mesto povtornykh operatsiy pri al'veokokkoze [The role and the place of redo surgery for alveococcosis.] Collection of materials of the XIX International Congress of Hepatology Surgeons of Russia and CIS countries “Actual problems of surgical hepatology”. Irkutsk, 19–21 september, 2012. P. 87. http://hepatoassociation.ru/congress/work. (In Russian)