title: Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis.
abstract: BACKGROUND
  Alveolar echinococcosis is a rare disorder, which makes a comparison of different treatment modalities within a clinical trial difficult to perform. Data prospectively recorded over a period of 25 years were used to evaluate three therapeutic strategies: benzimidazole therapy alone, complete 'curative' resection followed by 2 years of adjuvant benzimidazole treatment, and partial debulking resection followed by continuous administration of a benzimidazole.
  
  
  METHODS
  Details of 113 patients with hepatic alveolar echinococcosis treated between 1976 and 2003 were analysed. Kaplan-Meier survival curves were constructed and, using a Cox regression model, patient age, year of initial treatment and PNM stage were entered as co-variates in the analysis.
  
  
  RESULTS
  Kaplan-Meier overall survival curves stratified for treatment strategy indicated an improved long-term survival in patients undergoing the debulking procedure (P = 0.061) or curative resection (P = 0.002) compared with benzimidazole therapy alone. However, when PNM stage, patient age and year of initial treatment were introduced into the analysis, there was a trend for survival advantage only with curative resection (P = 0.07 versus benzimidazole alone). Debulking resulted in a higher rate of progression of hepatic echinococcosis than curative surgery (P = 0.008). The incidence of parasite-related complications was similar for debulking resection and benzimidazole therapy alone (P = 0.706).
  
  
  CONCLUSIONS
  Debulking hepatic resections do not appear to offer any advantage in the treatment of patients with alveolar echinococcosis.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Z
authors.initials: Z
authors.lastname: Kadry
authors.forename: E C
authors.initials: EC
authors.lastname: Renner
authors.forename: L M
authors.initials: LM
authors.lastname: Bachmann
authors.forename: N
authors.initials: N
authors.lastname: Attigah
authors.forename: E L
authors.initials: EL
authors.lastname: Renner
authors.forename: R W
authors.initials: RW
authors.lastname: Ammann
authors.forename: P-A
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use*; D000871:Anthelmintics / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004444:Echinococcosis, Hepatic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008463:Mebendazole / Q000627:therapeutic use*; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D008463:Mebendazole; D015766:Albendazole