1
|
A new treatment strategy for end-stage hepatic alveolar echinococcosis: IVC resection without reconstruction. Sci Rep 2019; 9:9419. [PMID: 31263143 PMCID: PMC6602961 DOI: 10.1038/s41598-019-45968-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022] Open
Abstract
Patients with hepatic alveolar echinococcosis (HAE) infringing on the inferior vena cava (IVC) have a poor prognosis when radical resection cannot be performed because curative resection is limited by IVC reconstruction. There is little information concerning combined resection of the liver and the IVC. This study explored a novel treatment method for HAE infringing on the IVC and evaluated the safety and feasibility of combined resection of the liver and the IVC. A total of 13 patients were treated with liver resection combined with IVC resection for end-stage HAE between January 2016 and July 2018 at the Affiliated Hospital of Qinghai University. The demographic, clinical, and follow-up data were collected and analysed. The 13 patients underwent resection of the IVC without reconstruction. Of these, 3 exhibited oedema of both lower limbs and the scrotum (23.1%), 2 exhibited pneumothorax (15.4%), 1 exhibited bile leakage (7.7%), 1 exhibited bacteraemia (7.7%), and 1 developed abdominal haemorrhage that was stopped with conservative treatment (7.7%). There was 1 case of operation-related mortality because of upper gastrointestinal haemorrhage (7.7%), and no patients developed recurrence or had residual lesions. Liver resection combined with IVC resection is effective and feasible for patients with HAE infringing on the IVC.
Collapse
|
2
|
Vuitton DA, Azizi A, Richou C, Vuitton L, Blagosklonov O, Delabrousse E, Mantion GA, Bresson-Hadni S. Current interventional strategy for the treatment of hepatic alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 14:1179-1194. [DOI: 10.1080/14787210.2016.1240030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
3
|
Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work? ACTA ACUST UNITED AC 2014; 21:75. [PMID: 25531730 PMCID: PMC4273701 DOI: 10.1051/parasite/2014071] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022]
Abstract
Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.
Collapse
Affiliation(s)
- Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy
| | - Lucine Vuitton
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy - Division of Tropical Infectious Diseases, San Matteo Hospital Foundation, Via Taramelli 5, 27100 Pavia, Italy
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Stéphane Koch
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| |
Collapse
|
4
|
Abstract
Hydatid disease can result in cystic liver disease. If a conservative treatment fails, these cysts require resection. Involvement of the inferior vena cava requiring resection for hydatid disease is unusual. We present a case of hydatid disease with complete caval obstruction and resultant portal hypertension that required combined liver resection and inferior vena cava replacement.
Collapse
Affiliation(s)
- Kristin L Mekeel
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
| | | |
Collapse
|
5
|
Kadry Z, Renner EC, Bachmann LM, Attigah N, Renner EL, Ammann RW, Clavien PA. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg 2005; 92:1110-6. [PMID: 16044412 DOI: 10.1002/bjs.4998] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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). CONCLUSION Debulking hepatic resections do not appear to offer any advantage in the treatment of patients with alveolar echinococcosis.
Collapse
Affiliation(s)
- Z Kadry
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Two Echinococcus species may exhibit medical relevance as causative agents of pulmonary forms of echinococcosis. Most importantly, infections with Echinococcus granulosus result in "cystic hydatid disease" or "cystic echinococcosis," which affects the lungs in a considerable ratio of cases. Echinococcus multilocularis, which causes "alveolar echinococcosis," affects the lungs relatively rarely and then usually upon metastasizing from primary hepatic lesions. Cystic echinococcus and alveolar echinococcus differ pathologically and clinically so greatly that they are considered separately in this article, although alveolar echinococcus is covered minimally because of its minor importance regarding lung infections.
Collapse
Affiliation(s)
- Bruno Gottstein
- Institute of Parasitology, University of Berne, Länggass-Strasse 122, CH-3012 Berne, Switzerland.
| | | |
Collapse
|
7
|
Rozanes I, Acunaş B, Emre A, Alper A, Sayi I, Minareci Ö, Acarli K, Hazar H, Ariogul O. CT staging of alveolar echinococcosis of the liver. Eur Radiol 1995. [DOI: 10.1007/bf00185309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|