ObjectiveTo explore the influencing factors of textbook outcomes (TO) after radical resection for hepatic alveolar echinococcosis (HAE). MethodsClinical data from 427 patients diagnosed with HAE at the Ganzi Branch of West China Hospital, Sichuan University, between 2015 and 2022, were retrospectively collected. The least absolute shrinkage and selection operator regression (LASSO) was first used to screen potential influencing factors for achieving TO (predictive model A). Univariate and multivariate logistic regression analysis were then used to explore the influencing factors of TO (predictive model B). A Nomogram was further constructed and validated. ResultsA total of 427 patients who successfully underwent radical liver resection were included, of which 174 patients (40.7%) achieved TO. Compared to the non-TO group, patients in the TO group had higher proportions of WHO PNM stage of P 1+2 [62.6% (109/174) vs 42.3% (140/253)], N0 [77.0% (134/174) vs 63.6% (161/253)], lesion diameter≤10 cm [77.0% (134/174) vs 64.8% (164/253)], albumin-bilirubin index (ALBI) ≤–2.6 [70.1% (122/174) vs 59.3% (150/253)], and minor liver resection [71.8% (125/174) vs 50.2% (127/253)], higher prealbumin (181 mg/L vs 169 mg/L) and albumin (39 g/L vs 38 g/L) levels, shorter postoperative hospital stay (15 d vs 19 d), and lower hospitalization costs (51 727 RMB vs 62 715 RMB), P<0.05. LASSO regression analysis indicated that P stage, lesion diameter, ALBI, and liver resection method were potential influencing factors for achieving TO after HAE surgery (model A), P<0.05. The TO rate for P 1+2 stage was higher than that of P 3+4 stage, the TO rate for lesion diameter ≤ 10 cm was higher than that of lesion diameter >10 cm, the TO rate for ALBI ≤–2.6 was higher than that of ALBI >–2.6, and the TO rate for minor liver resection was higher than of major liver resection. Multivariate logistic regression analysis showed that P stage (OR=1.800, P=0.025) and liver resection method (OR=1.974, P<0.001) were influencing factors for achieving TO (model B). The TO rates for P1+2 stage and minor liver resection were higher. Predictive model A demonstrated higher accuracy and stability compared to predictive model B (AUC: 0.754 vs 0.712, C-index: 0.756 vs 0.707). ConclusionsAmong patients undergoing radical resection for HAE, less than half achieved TO. Striving to achieve TO can significantly shorten the length of hospital stay and effectively reduce medical costs. The TO predictive model based on P stage, lesion diameter, ALBI, and liver resection method is superior to the model based solely on P stage and liver resection method.
ObjectiveTo summarize short-term and long-term effects of ex vivo liver resection followed by autotransplantation (Abbreviation: autotransplantation) in treatment of advanced hepatic alveolar echinococcosis (HAE).MethodThe clinical data and follow-up data of 17 patients with advanced HAE who underwent autotransplantation from November 2016 to July 2019 in the Ganzi Tibetan Autonomous Prefecture People’s Hospital were retrospectively analyzed.ResultsThe autotransplantations were performed successfully in the 17 patients with advanced HAE. Ten patients underwent the inferior vena cava (IVC) reconstruction with autologous saphenous veins, 5 patients underwent the artificial revascularization, 1 patient underwent the direct anastomosis of the original IVC, and 1 patient didn’t reconstructed (the retroperitoneal collateral circulation was abundant). The mean liver graft mass was 681.3 g (365–1 350 g) and operation time was 11.5 h (9–16 h). The median anhepatic period was 312 min (175–450 min), blood loss was 2 000 mL(950–4 500 mL), red blood cell suspension transfusion was 6.4 U (1–20 U), and fresh frozen plasma was 1.1 L (0.8–2.0 L). The postoperative hospital stay was 5 to 45 d with an average of 25.6 d. There were 4 patients with the postoperative hepatic enveloping effusion, 1 patient with bile leakage, and 1 patient with bile duct stenosis. All of them were treated and cured, and no death occurred. The follow-up time of 17 patients was 3 to 35 months with an average of 9.5 months, no recurrence of HAE and distant metastasis were observed.ConclusionsIn highlands, autotransplantation in treatment of advanced HAE patients with different IVC reconstruction is satisfactory, but it has a higher risk and is difficult. Choice of intraoperative reconstruction materials, judgment of posterior peritoneal collateral circulation, presence or absence of tension in end-to-end anastomosis of the IVC require precise consideration. At the same time, anticoagulation therapy and complications management are difficult, and it is only suitable for plateau medical center with rich experience.