Surgical treatment strategies for hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIU Yiwen ¹ , PANG Huasheng ² , SHEN Shu ¹ , WANG Tao ¹ , YANG Yi ¹ ,  WANG Wentao ¹

1. Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. NHC Key Laboratory of Echinococcosis Prevention and Control, Tibet Center of Disease Control and Prevention, Tibet Autonomous Region, Lhasa 850000, P. R. China;

Corresponding author：

WANG Wentao, Email: wwtdoctor02@163.com

Keywords：

hepatic alveolar echinococcosis; liver hydatid disease; surgical treatment; liver resection; laparoscope; ablation therapy; liver transplantation

DOI：

10.7507/1007-9424.202410022

Video：

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Hepatic alveolar echinococcosis (HAE) is a severe zoonotic disease caused by Echinococcus multilocularis, primarily affecting the liver. Due to its insidious nature, the patients are often diagnosed at advanced stage, posing significant treatment challenges. We comprehensively examines the progress in surgical techniques for HAE management, focusing on various strategies across different disease stages. For the patients with early-stage HAE, ablation therapy has emerged as an effective treatment option. In the moderate to advanced cases, numerous surgical techniques and innovative approaches have been introduced, including laparoscopic surgery and liver transplantation, with particular emphasis on ex vivo liver resection and autotransplantation. These advancements offer more effective treatment options for the patients with advanced HAE. However, significant challenges persist, notably the preservation of adequate liver function while achieving complete lesion removal. Future research should prioritize the exploration and optimization of existing surgical methods, especially for advanced HAE cases. This includes refining surgical techniques through precise preoperative evaluation and staging, as well as developing novel surgical approaches to enhance safety and efficacy. Furthermore, multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies. Through these concerted efforts, it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved, marking a new era in the management of this complex disease.

Citation： QIU Yiwen, PANG Huasheng, SHEN Shu, WANG Tao, YANG Yi, WANG Wentao. Surgical treatment strategies for hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(10): 1153-1159. doi: 10.7507/1007-9424.202410022 Copy

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1. McManus DP, Zhang W, Li J, et al. Echinococcosis. Lancet, 2003, 362(9392): 1295-1304.
2. McManus DP, Gray DJ, Zhang W, et al. Diagnosis, treatment, and management of echinococcosis. BMJ, 2012, 344: e3866. doi: 10.1136/bmj.e3866.
3. 温浩, 李海涛. 肝包虫病的外科手术及药物治疗进展. 中国动物保健, 2017, 19(7): 29-32.
4. Romig T, Kratzer W, Kimmig P, et al. An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Römerstein Study Group. Am J Trop Med Hyg, 1999, 61(4): 566-573.
5. da Silva AM. Human echinococcosis: a neglected disease. Gastroenterol Res Pract, 2010, 2010: 583297. doi: 10.1155/2010/583297.
6. Schweiger A, Ammann RW, Candinas D, et al. Human alveolar echinococcosis after fox population increase, Switzerland. Emerg Infect Dis, 2007, 13(6): 878-882.
7. Wen H, Vuitton L, Tuxun T, et al. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev, 2019, 32(2): e00075-18. doi: 10.1128/CMR.00075-18.
8. Kui Y, Han S, Zhang X, et al. Analysis of epidemiological and issues encountered in case reports on echinococcosis—China, 2022. China CDC Wkly, 2024, 6(6): 100-104.
9. Wang LY, Qin M, Liu ZH, et al. Prevalence and spatial distribution characteristics of human echinococcosis in China. PLoS Negl Trop Dis, 2021, 15(12): e0009996. doi: 10.1371/journal.pntd.0009996.
10. 蒉嫣, 薛垂召, 王旭, 等. 2022年全国棘球蚴病防治工作进展. 中国寄生虫学与寄生虫病杂志, 2024, 42(1): 8-16.
11. 王国强. 全国包虫病流行情况调查报告. 上海: 上海科学技术出版社, 2016.
12. Craig PS, Giraudoux P, Wang ZH, et al. Echinococcosis transmission on the Tibetan Plateau. Adv Parasitol, 2019, 104: 165-246.
13. 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 泡型肝包虫病诊疗专家共识(2020版). 中国普外基础与临床杂志, 2020, 27(1): 13-17.
14. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(8): 711-721.
15. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int, 2006, 55 Suppl: S283-S287. doi: 10.1016/j.parint.2005.11.041.
16. 温浩, 栾梅香, 杨文光, 等. 肝包虫病的标准化分型及临床意义探讨. 新疆医科大学学报, 2002, 25(2): 129-130.
17. Qiu Y, Yang X, Shen S, et al. Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation. Surgery, 2019, 165(5): 889-896.
18. 邱逸闻, 杨先伟, 沈舒, 等. 计算机三维可视化重建技术在肝泡型包虫病切除术中的应用. 中国普外基础与临床杂志, 2018, 25(5): 540-546.
19. He YB, Bai L, Aji T, et al. Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis. World J Gastroenterol, 2015, 21(35): 10200-10207.
20. 栗海龙, 候立朝, 任利, 等. MRI在泡型肝包虫病术前评估中作用的研究. 中国普外基础与临床杂志, 2016, 23(5): 535-538.
21. 郭兵, 庞明泉, 许晓磊, 等. 预测两型肝包虫病肝切除术后并发症列线图的建立及评价. 临床肝胆病杂志, 2021, 37(11): 2626-2631.
22. 于鹏, 段绍斌. 术前MELD评分对肝包虫病患者手术后并发症和远期预后的评估价值. 肝脏, 2023, 28(2): 229-232, 237.
23. Liang Y, Zhang Z, Dai Z, et al. Comparative study of indocyanine green (ICG)-R15 and Albumin-Indocyanine Green Evaluation (ALICE) grading system in the prediction of posthepatectomy liver failure and postoperative mortality in patients with hepatic alveolar echinococcosis. BMC Gastroenterol, 2022, 22(1): 297. doi: 10.1186/s12876-022-02367-x.
24. Ren B, Chen X, Lei P, et al. The relationship between preoperative systemic immune inflammation index and prognostic nutritional index and the prognosis of patients with alveolar hydatid disease. Front Immunol, 2021, 12: 691364. doi: 10.3389/fimmu.2021.691364.
25. Wang T, Yang X, Wang W, et al. A new sarcopenia score prognostic for postoperative complications in hepatic alveolar echinococcosis: a multicenter retrospective study. Ann Transl Med, 2020, 8(21): 1398. doi: 10.21037/atm-20-1960a.
26. 四川省医师协会包虫病专业委员会. 四川省肝泡型包虫病消融治疗技术规范. 中国普外基础与临床杂志, 2018, 25(11): 1304-1307.
27. Cairang Y, Zhang L, Ren B, et al. Efficacy and safety of ultrasound-guided percutaneous microwave ablation for the treatment of hepatic alveolar echinococcosis: A preliminary study. Medicine (Baltimore), 2017, 96(27): e7137. doi: 10.1097/MD.0000000000007137.
28. Deng X, Wang JJ, Wang ZX, et al. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for hepatic alveolar echinococcosis. BMC Med Imaging, 2022, 22(1): 27. doi: 10.1186/s12880-022-00752-2.
29. Deng X, Wang JJ, Huang HS, et al. Analysis of the efficacy of microwave ablation in the treatment of early hepatic alveolar echinococcosis: A propensity score matching based study. Acta Trop, 2022, 228: 106307. doi: 10.1016/j.actatropica.2022.106307.
30. A J, Chai J, Shao Z, et al. Comparison of local ablation with Albendazole or laparoscopic hepatectomy combined with Albendazole in the treatment of early hepatic alveolar echinococcosis. Front Public Health, 2022, 10: 960635. doi: 10.3389/fpubh.2022.960635.
31. Asiyanbola B, Chang D, Gleisner AL, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable?. J Gastrointest Surg, 2008, 12(5): 842-851.
32. Wan L, Wang T, Cheng L, et al. Laparoscopic treatment strategies for liver ehinococcosis. Infect Dis Ther, 2022, 11(4): 1415-1426.
33. Kawamura N, Kamiyama T, Sato N, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg, 2011, 212(5): 804-812.
34. Chen KF, Tang YY, Wang R, et al. The choose of different surgical therapies of hepatic alveolar echinococcosis: A single-center retrospective case-control study. Medicine (Baltimore), 2018, 97(8): e0033. doi: 10.1097/MD.0000000000010033.
35. Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: A single-center cohort study. World J Surg, 2015, 39(10): 2529-2534.
36. Sato N, Namieno T, Furuya K, et al. Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis. J Gastroenterol, 1997, 32(3): 351-354.
37. Hillenbrand A, Gruener B, Kratzer W, et al. Impact of safe distance on long-term outcome after surgical therapy of alveolar echinococcosis. World J Surg, 2017, 41(4): 1012-1018.
38. Efanov M, Alikhanov R, Tsvirkun V, et al. Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB (Oxford), 2017, 19(9): 818-824.
39. Wan L, Ran B, Aji T, et al. Laparoscopic or open treatment for hepatic alveolar echinococcosis: A single-institution experience. Int J Infect Dis, 2021, 107: 182-187.
40. Wan L, Ran B, Aji T, et al. Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis. Parasite, 2021, 28: 5. doi: 10.1051/parasite/2021001.
41. Gloor S, Candinas D, Beldi G, et al. Laparoscopic resection of hepatic alveolar echinococcosis: A single-center experience. PLoS Negl Trop Dis, 2022, 16(9): e0010708. doi: 10.1371/journal.pntd.0010708.
42. Shen HD, Chen KF, Li B, et al. Two-stage hepatectomy for multiple giant alveolar echinococcosis. Medicine (Baltimore), 2017, 96(33): e7819. doi: 10.1097/MD.0000000000007819.
43. Hong Y, Li H, Teng F, et al. Two-step resection procedure for advanced hepatic alveolar echinococcosis: First case-series report. Asian J Surg, 2023, 46(11): 4829-4830.
44. Guiu B, Quenet F, Panaro F, et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
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