Surgical treatment of alveolar echinococcosis and the long-term results

Introduction: The incidence of alveolar echinococcosis (AE) is low, and stu dies and progress reports with regard to surgical procedures are rare. Meth ods: Retrospective analysis of surgical therapy of AE and its long-term res ults between 1983 and 2000 by evaluating medical records and questionnaires , Setting: German university; hospital within the endemic area. Results: Tw enty-five surgical procedures were performed in 19 patients with AE (12 x p artial resection of the liver, 3 of them with additional extrahepatic resec tion; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x expl oratory laparotomy, 1x bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, becau se the parasitic mass could not be resected in tote. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28%. All patients had additional med ical treatment and periodic follow-up. Three of seven patients estimated fo r curative surgery developed a relapse. One of the patients discharged foll owing palliative surgery died 13 years after diagnosis with liver insuffici ency. Advances in conservative and interventional treatments have greatly i mproved the prognosis of the disease. Conclusion: Curative surgery for AE i s feasible only in a minority of patients, because frequently the disease h as already spread widely when diagnosed. The minimum distance between the l esion and the cut surface should be 2 cm. Taking the advances in conservati ve treatment into consideration, the benefit of palliative surgery is uncer tain and today there is no evidence for prolonged survival by palliative su rgical procedures. Palliative surgery should therefore be reserved for case s with complications that could not be managed by conservative and interven tional treatment.