title: Alveolar echinococcosis in Turkey. Experience from an endemic region.
abstract: BACKGROUND
  Radical resection is the only potentially curative treatment for hepatic alveolar echinococcosis (AE). Although Turkey is an endemic region, population screening is not performed and early diagnosis is rare. Consequently, surgeons are compelled to explore possibilities such as near-total resection and biliodigestive anastomosis for palliation of jaundice.
  
  
  METHODS
  Surgery was performed in 32 patients with hepatic AE with the following indications: (1) resection; (2) palliation of jaundice; (3) definite assessment of operability; (4) failure in the management of cavity infection by percutaneous methods. Curative resection (R0 = complete resection of all parasitic mass [n = 9], and R1 = a resection in which a small remnant was left on a vital structure [n = 8]) were performed in 17 patients, intrahepatic cholangiojejunostomy in 7, laparotomy-external drainage in 7, and debulking in 1.
  
  
  RESULTS
  Perioperative mortality rates were 2/17, 0/7, 2/7 and 1/1, respectively. Twelve patients in the curative resection group are alive without recurrence/progression of the small remnant during a median follow-up of 59 (range 27-116) months. One patient developed an inoperable recurrence that was treated with albendazole. One patient was lost to follow-up. Long-term albendazole treatment was effective in all R1 patients except a patient who had slow asymptomatic progression. Successful palliation of jaundice was achieved in 5 of the 7 intrahepatic cholangiojejunostomy patients.
  
  
  CONCLUSIONS
  The results of R1 resection in alveolar hydatid disease are similar to those of R0 resection; a small remnant is successfully controlled by albendazole. In patients with jaundice due to hilar invasion, biliary diversion from segment 3 or 5 is effective for palliation of the jaundice and facilitates albendazole treatment.
authors.affiliation: Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. aemre@turk.net
authors.forename: Ali
authors.initials: A
authors.lastname: Emre
authors.forename: Ilgin
authors.initials: I
authors.lastname: Ozden
authors.forename: Orhan
authors.initials: O
authors.lastname: Bilge
authors.forename: Cumhur
authors.initials: C
authors.lastname: Arici
authors.forename: Aydin
authors.initials: A
authors.lastname: Alper
authors.forename: Attila
authors.initials: A
authors.lastname: Okten
authors.forename: Bülent
authors.initials: B
authors.lastname: Acunas
authors.forename: Izzet
authors.initials: I
authors.lastname: Rozanes
authors.forename: Koray
authors.initials: K
authors.lastname: Acarli
authors.forename: Yaman
authors.initials: Y
authors.lastname: Tekant
authors.forename: Orhan
authors.initials: O
authors.lastname: Ariogul
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000379:methods; D004444:Echinococcosis, Hepatic / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000871:Anthelmintics; D015766:Albendazole