Surgical treatment of alveolar echinococcosis of the liver

Cure of alveolar echinococcosis of the liver can be achieved by complete removal of the lesion, this being possible only by hepatic resection. Nevertheless, 25% of patients have unresectable lesions. The purpose of this work was to analyze the clinical sequelae and prognosis of patients after curative and palliative surgery for alveolar echinococcosis of the liver. The 10-year survival rate of patients who underwent hepatectomy with complete resection of the lesion was 100% compared with 63% in the patients who had hepatectomy with incomplete resection of the lesion. Thirty-seven patients with unresectable hepatic echinococcosis were divided into two groups; the 10 patients in group A underwent only exploratory laparotomy, and the 27 patients in group B had palliative surgery. In group B, marsupialization or cyst drainage was performed in 17 patients, biliary drainage in 6 patients, and biliary reconstruction in 4 patients. The outcome after surgery was compared in the two groups. The 5-year survival of the patients in group A was 30%, and all patients died of liver failure within 7 years. The survival rates of patients in group B were 60% at 5 years, 55% at 10 years, and 35% at 15 years. Complete removal of the lesion by hepatectomy results in satisfactory prognosis. Palliative surgery may offer improvement in terms of survival and quality of life when complete removal is not possible.