[Surgical therapy of alveolar echinococcosis and long-term outcome].
BACKGROUND
The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare.


METHODS
Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires.


METHODS
German university hospital within the endemic area.


RESULTS
Twenty-five surgical procedures were performed in 19 patients with AE (12x partial resection of the liver, 3 of them with additional extrahepatic resection; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x exploratory 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, because the parasitic mass could not be resected in toto. 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 medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease.


CONCLUSIONS
Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.
Buttenschoen
K
K
Chirurgische Klinik I, Universität Ulm. klaus.buttenschoen@medizin.uni-ulm.de
Schorcht
P
P
Reuter
S
S
Buttenschoen
D C
DC
Kern
P
P
Beger
H G
HG
D000328:Adult; D000368:Aged; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D014057:Tomography, X-Ray Computed