Two-stage hepatectomy for multiple giant alveolar echinococcosis

Abstract

Alveolar echinococcosis is a chronically progressive and potentially fatal disease. Patients with multiple giant alveolar echinococcosis have a poor prognosis when radical resection cannot be achieved, but curative resection can be limited by low future remnant liver volumes. In these cases, 2-stage liver resection may be a better choice: after a first-stage hepatectomy with partial resection, liver regeneration is allowed in the residual liver before proceeding to the second-stage hepatectomy. In this study, we therefore retrospectively reviewed and evaluated the safety and feasibility of two-stage hepatectomy in patients with multiple giant alveolar echinococcosis.We reviewed the data for all patients who underwent 2-stage hepatectomy for multiple giant alveolar echinococcosis between August 2013 and December 2015 at either the West China Hospital of Sichuan University or the Hospital of Ganzi Tibetan Autonomous Prefecture.We identified 7 patients in whom 2-stage hepatectomy was completed. During the first-stage hepatectomy, 4 patients underwent right-sided hepatectomy and the other 3 underwent left-sided hepatectomy. The second-stage hepatectomies were successfully performed 3 months after the first-stage procedures. All patients had follow-up durations of >1 year; there were no cases of operation-related mortality, and no patients experienced disease recurrence.Two-stage hepatectomy is safe and feasible for patients with multiple giant alveolar echinococcosis.

Complicated Clinical Course of a Patient with Multivisceral Cystic Echinococcosis Requiring Extensive Surgical and Medical Treatment

“…Surgical treatment is considered to ensure healing in the case of CE, because it completely removes the cause of the disease [26], but medical treatment must be associated with surgical therapy in order to prevent hydatid recurrence. When patients with CE cannot be operated on-either due to contraindications (e.g., associated diseases) or the locations being difficult to reach, the cysts being very small, or the presence of numerous tiny cysts-the only option is medical therapy [7,16,[21][22][23][24][25].…”

Application of hepatic lobe hyperplasia techniques in the treatment of advanced hepatic alveolar echinococcosis: a single-centre experience

“…Previous literature has reported the use of PVE or TSH on patients suffering from hepatic AE with insufficient FLRV in a small sample size or in a limited form of case report. Shen et al have reported that seven patients with advanced multiple giant hepatic AE were treated through TSH, which effectively reduced the operation risk and achieved radical resection [ 43 ]. Similarly, these seven patients had at least two lesions and the FLRV was less than 30% of the total liver volume.…”

Current status of ex-vivo liver resection and autologous liver transplantation for end-stage hepatic alveolar echinococcosis

“…Gruttadauria et al indicated postoperative liver failure after hepatic resection for patients is highly occurred when the RLV less than 30% (45). Based on this index (RLV =30%), Shen et al made the surgical plan as whether resect the lesions in one stage or not for multiple giant HAE patients (46). Based on the author's experience, the RLV should be more than 30% for "health" liver before ERAT.…”