title: Profile of patients with hepatic hydatid disease not treated surgically.
abstract: BACKGROUND
  hepatic hydatid disease (HHD) is still an important health problem in certain areas of Spain where it is endemic. The treatment of HHD is usually surgical but certain patients are found to be ineligible after assessment for surgery (asymptomatic disease, comorbidity, patient refusal, or other).
  
  
  METHODS
  description of patients assessed in the Department of Surgery for hepatic hydatid disease.
  
  
  RESULTS
  in a group of 70 patients with HHD, 27 patients were not treated surgically (mean age: 72.7 years [range: 47-97], 14 women [51.8%]). The number of cysts presented by these patients was 33, with 1.22 cyst/patient (range: 1-4). The cyst size was 5.5 cm (range: 2.1-12.5 cm). The cysts, according to the WHO classification, were CE1: 3 patients, CE3B: 5 patients, CE4: 10 patients and CE5: 9 patients. The form of presentation was: symptomatic in 9 patients, although only 6 were attributable to HHD (22%) and asymptomatic in 18 patients. In these cases, imaging was performed for study of tumor extension in 6 patients and diverse medical reasons in 12. Only two therapeutic interventions were performed: endoscopic retrograde cholangiopancreatography (ERCP) with insertion of a bile duct stent, and puncture-aspiration-injection-re-aspiration (PAIR), both in patients who did not wish to undergo surgery.Ten patients had surgical indications: CE1 (3 patients), CE3B (5 patients), CE4 (1 patient), and CE5 (1 patient). The reasons why the patients did not undergo surgical treatment were: refusal (9 patients) and advanced neoplasm (1 patient). Surgery was judged necessary in 5 patients. In the mean follow-up period of 17 months (range: 1-37), no surgery was performed.
  
  
  CONCLUSIONS
  there were various causes for not performing surgical intervention of HHD after medical evaluation: asymptomatic patients, older patients, patients with multiple pathologies and oncologic patients. Usually, they were patients who voluntarily chose not to undergo surgery.
authors.affiliation: Unit of Hepato-Bilio-Pancreatic Surgery, Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, C/ Donante de Sangre s/n, Guadalajara, Spain
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ramia
authors.forename: Roberto
authors.initials: R
authors.lastname: de-la-Plaza
authors.forename: Miguel
authors.initials: M
authors.lastname: Casares
authors.forename: Carmen
authors.initials: C
authors.lastname: Ramiro
authors.forename: Pilar
authors.initials: P
authors.lastname: Veguillas
authors.forename: José
authors.initials: J
authors.lastname: Quiñones
authors.forename: Jorge
authors.initials: J
authors.lastname: García-Parreño
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058345:Asymptomatic Infections; D003430:Cross-Sectional Studies; D004444:Echinococcosis, Hepatic / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain; D016312:Treatment Refusal