title: Outcomes After Liver Resection for Hepatic Alveolar Echinococcosis: A Single-Center Cohort Study.
abstract: BACKGROUND
  Switzerland is a region in which alveolar echinococcosis (AE) is endemic. Studies evaluating outcomes after liver resection (LR) for AE are scarce. The aim of this study was to assess the short- and long-term outcomes of AE patients after LR in a single tertiary referral center.
  
  
  METHODS
  We retrospectively analyzed data pertaining to all patients with liver AE who were treated with LR at our institution between January 1992 and December 2013. Patient demographics, intraoperative data, extent of LR procedures (major vs. minor LR), postoperative outcomes, and negative histological margin (R0) resection rate were recorded in a database. Recurrence rates after LR were analyzed.
  
  
  RESULTS
  LR was performed in 59 patients diagnosed with hepatic AE (56 complete surgeries, 3 reduction surgeries). Postoperative morbidity and mortality were observed in 34 % (25 % grade I-II, 9 % grade III-IV) and 2 % of the patients, respectively. R0 (complete) resection rate was 71 % (n = 42), and R1/R2 resection rate was 29 % (n = 17). Extra-hepatic recurrence occurred in 1 case (lung) after R0 resection. In cases of R1/R2 resection, 7 intra-hepatic disease progressions occurred with a median time of 10 months (IQR 6-11 months). Long-term (more than 1 year) benzimidazole treatment stabilized the disease in 64 % (9/14) of patients with R1 status. The overall survival rate was 97 %.
  
  
  CONCLUSIONS
  Liver AE can be safely and definitively treated with LR, provided that R0 resection is achieved. In cases of R1 resection, benzimidazole therapy seems to be effective in stabilizing the intra-hepatic disease and preventing extra-hepatic recurrence.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland, gaetan.joliat@gmail.com.
authors.forename: Gaëtan-Romain
authors.initials: GR
authors.lastname: Joliat
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Melloul
authors.forename: David
authors.initials: D
authors.lastname: Petermann
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Michel
authors.initials: M
authors.lastname: Gillet
authors.forename: Emilie
authors.initials: E
authors.lastname: Uldry
authors.forename: Nermin
authors.initials: N
authors.lastname: Halkic
mesh_terms: D000368:Aged; D000871:Anthelmintics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D001562:Benzimidazoles; C031000:benzimidazole