Alveolar echinococcosis in Turkey. Experience from an endemic region.
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.
Emre
Ali
A
Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. aemre@turk.net
Ozden
Ilgin
I
Bilge
Orhan
O
Arici
Cumhur
C
Alper
Aydin
A
Okten
Attila
A
Acunas
Bülent
B
Rozanes
Izzet
I
Acarli
Koray
K
Tekant
Yaman
Y
Ariogul
Orhan
O
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
D000871:Anthelmintics; D015766:Albendazole