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Alveolar Hydatid Disease of the Liver: a Report on Thirty-Nine Surgical Cases in Eastern Anatolia, Turkey

The charts of 39 consecutive patients who underwent surgery between 1979 and 1989 with a diagnosis of alveolar hydatid disease (AHD) of the liver were reviewed. The analysis of these cases from eastern Anatolia, which is the endemic region in Turkey, was undertaken to determine the current experience for AHD lesions.

Of these patients, 33 (84.6%) had unresectable disease and the remaining six patients (15.4%) were treated by hepatic resection of the primary lesion. In the unresectable cases, laparotomy with biopsy was the most commonly used surgical procedure (56.4%), followed by tube drainage of the necrotic cavity (18.0%), marsupialization (5.1%), and cystojejunostomy (5.1%).

Diagnostic studies and operative findings were useful in detecting the AHD lesions. Differential diagnosis was established mainly by histopathologic examination of a biopsy specimen or resected tissue. Pulmonary metastases were seen in two cases, and mortality occurred due to brain metastases in two other cases. Mebendazole was administered post-operatively to 19 patients with indications for 1) advanced AHD, 2) adjuvant therapy to radical and palliative surgical procedures, and 3) recurrences of disease after hepatic resection. The patients were treated with daily doses of approximately 50 mg/kg for periods of one and six years (median 3.2 years). Encouraging results were obtained in 11 of nineteen patients. Five-year survival was seen in 8 of the patients with AHD in this series. There were 18 deaths (46.2%) in our 39 patients. Long-term follow-up was not possible in four cases, and 17 patients (43.6%) were still living. The causes of mortality were advanced AHD in 14 cases, brain metastases in two, and acute myocardial infarction in another two. These clinical data suggest that a combination of surgery with chemotherapy can improve the results in selected cases.