Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis

Abstract

Background In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy. Methods A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732). Results Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9–23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5–13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6–9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8–1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1–6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years. Conclusion Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.

Association between radical versus conservative surgery and short-term outcomes of hepatic cystic echinococcosis in Nyingchi, China: a retrospective cohort study

“…Post-surgical bile leakage is risk factor of morbidity after surgery [ 3 , 21 , 22 ]. The incidence is reported to be ranged from 8.5% to 64.5% in CS group in different literatures [ 3 , 23 – 25 ]. Georgiou GK, et al [ 9 ] found a lower rate of developing post-operative bile leak in the RS group than CS group (3.48% vs 8%).…”

Clinical characteristics and antibodies against Echinococcus granulosus recombinant antigen P29 in patients with cystic echinococcosis in China

“…Similar to other studies, 8 (25.9%) of our patients were asymptomatic at diagnosis, and among them, 2 relapsed cases were identified in the postoperative annual ultrasound examination, and the remaining 6 newly-diagnosed patients were observed during physical examination. Previous studies revealed the recurrence rate after surgery varied between 1.5 and 6.3% [ 40 ]. According to Gulsun et al [ 41 ], recurrence cases were observed 3 years following surgery.…”

Natural Products as Therapeutic Option for Echinococcossis

“…Owing to its satisfactory outcomes, surgery is considered the preferred treatment modality for CE patients with large and complicated cysts [16]. Nonetheless, benzimidazole must be administered to sterilize cyst content prior to surgical treatment in order to prevent dissemination or anaphylaxis [14].…”

“…In recent times, the use of conservative surgical procedures has become more acceptable among surgeons [19]. However, invasive surgery is sometimes still needed to eradicate parasitic infection in patients with complicated hepatic cysts and also in patients who do not respond to anthelmintic therapy [16]. In contrast to conservative techniques, radical techniques used in hepatic infections can include cystectomy and may involve removal of the germinative layer by non-anatomical liver resection.…”