Palliative operation for the treatment of alveolar echinococcosis.
BACKGROUND
The World Health Organization guidelines recommend radical hepatic resection for definite treatment of alveolar echinococcosis (AE), because it can cure the patient. However, parasitic masses are not entirely removable in about 70% of patients. Even so, palliative resections are carried out, although cure cannot be achieved. As conservative treatment has improved, the role of palliative surgical procedures has to be redefined.


METHODS
Critical appraisal of published reports on palliative resections for AE and estimation of the level of evidence and grade of recommendation.


RESULTS
Prospective randomized trials comparing palliative resections, radical resections, and conservative treatment are lacking. Most papers analyzed case series retrospectively. The number of palliative operations is significant. In the past, palliative resections were recommended in order to enhance anthelminthic drug efficacy but advances in conservative and interventional treatment improved the prognosis of AE. Prolonged survival by systematic palliative resections is not evident. However, palliative surgery is an option to treat persistent bacterial infection, fistulas, and obstructing or compressing masses. The indication is based on individual considerations and decisions.


CONCLUSIONS
Curative surgery for AE is feasible if parasitic tissue is entirely removable. The benefit of palliative resections is uncertain because long-term results of conservative treatment are favorable. Palliative surgery is an option for complications not being manageable otherwise.
Buttenschoen
Klaus
K
General, Visceral and Transplantation Surgery, University of Ulm, Steinhoevelstrasse 9, 89075, Ulm, Germany. klaus.buttenschoen@uniklinik-ulm.de
Gruener
Beate
B
Carli Buttenschoen
Daniela
D
Reuter
Stefan
S
Henne-Bruns
Doris
D
Kern
Peter
P
D015766:Albendazole / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004444:Echinococcosis, Hepatic / Q000401:mortality / Q000601:surgery*; D019317:Evidence-Based Medicine; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008463:Mebendazole / Q000627:therapeutic use; D010166:Palliative Care; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
D000923:Anticestodal Agents; D008463:Mebendazole; D015766:Albendazole