Advanced liver surgery for hepatic alveolar echinococcosis

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Background: Hepatic alveolar echinococcosis (HAE) is rare tumor-like mass caused by tapeworm Echinococcus multilocularis. The condition is characterized by asymptomatic development and invasive growth. Methods: Between February 2019 and August 2022, 11 patients underwent advanced liver surgery (extended resection or liver transplantation [LT]) for alveolar echinococcosis. Liver resection was performed in seven cases including four extended right hepatectomies with portal vein resection, two extended right hepatectomies with IVC replacement and one ex situ liver resection with IVC, portal vein replacement and venoplasty (all the procedures has been performed via cold perfusion); LT (deceased donor LT and living donor LT) was carried out in four cases, one of which the LT was supplemented by Whipple procedure due to duodenum and pancreas invasion. Results: All the patients successfully underwent procedures with no intra-nor early mortality. No palliative resections were performed. One patient died due to sepsis caused by vascular graft infection. There was not any biliary or vascular complication in LT group. Conclusions: Advanced liver resection seems a more complicated procedure than LT with higher complication rate. Both procedures demonstrate satisfying outcomes in patients with severe HAE.

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