Volume 96, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection ( = 15), palliative nonresective procedures ( = 13), OLT ( = 3), or albendazole therapy alone ( = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Ammann RW, Eckert J, , 1996. Cestodes. Echinococcus. Gastroenterol Clin North Am 25: 655689.[Crossref] [Google Scholar]
  2. Vuitton D, Meslin F, Eckert J, Pawlowski Z, Schantz P, Ammann R, Bresonhadni S, Dosongirete L, Gerard A, Miguet J, , 1996. Guidelines for treatment of cystic and alveolar echinococcosis in humans. Bull World Health Organ 74: 231242. [Google Scholar]
  3. Ammann RW, Fleiner-Hoffmann A, Grimm F, Eckert J, , 1998. Long-term mebendazole therapy may be parasitocidal in alveolar echinococcosis. J Hepatol 29: 994998.[Crossref] [Google Scholar]
  4. Maria AC, Celina EM, , 2014. Efficacy of albendazole in combination with thymol against Echinococcus multilocularis protoscoleces and metacestodes. Acta Trop 140: 6167.[Crossref] [Google Scholar]
  5. Kern P, Frosch P, Helbig M, Wechsler JG, Usadel S, Beckh K, Kunz R, Lucius R, Frosch M, , 1995. Diagnosis of Echinococcus multilocularis infection by reverse-transcription polymerase chain reaction. Gastroenterology 109: 596600.[Crossref] [Google Scholar]
  6. Wilson JF, Rausch RL, Wilson FR, , 1995. Alveolar hydatid disease. Review of the surgical experience in 42 cases of active disease among Alaskan Eskimos. Ann Surg 221: 315323.[Crossref] [Google Scholar]
  7. Davidson RK, Romig T, Jenkins E, Tryland M, Robertson LJ, , 2012. The impact of globalisation on the distribution of Echinococcus multilocularis . Trends Parasitol 28: 239247.[Crossref] [Google Scholar]
  8. Kern P, Bardonnet K, Renner E, Auer H, Pawlowski Z, Ammann RW, Vuitton DA, Kern P, , 2003. European echinococcosis registry: human alveolar echinococcosis, Europe, 1982–2000. Emerg Infect Dis 9: 343349.[Crossref] [Google Scholar]
  9. Deplazes P, Hegglin D, Gloor S, Romig T, , 2004. Wilderness in the city: the urbanization of Echinococcus multilocularis . Trends Parasitol 20: 7784.[Crossref] [Google Scholar]
  10. Piarroux M, Piarroux R, Knapp J, Bardonnet K, Dumortier J, Watelet J, Gerard A, Beytout J, Abergel A, Bresson-Hadni S, , 2013. Populations at risk for alveolar echinococcosis, France. Emerg Infect Dis 19: 721728.[Crossref] [Google Scholar]
  11. Joliat GR, Melloul E, Petermann D, Demartines N, Gillet M, Uldry E, Halkic N, , 2015. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg 39: 25292534.[Crossref] [Google Scholar]
  12. Farrokh D, Zandi B, Pezeshki Rad M, Tavakoli M, , 2015. Hepatic alveolar echinococcosis. Arch Iran Med 18: 199202. [Google Scholar]
  13. Aydinli B, Ozturk G, Arslan S, Kantarci M, Tan O, Ahiskalioglu A, Ozden K, Colak A, , 2015. Liver transplantation for alveolar echinococcosis in an endemic region. Liver Transpl 21: 10961102.[Crossref] [Google Scholar]
  14. Ozdemir F, Ince V, Barut B, Onur A, Kayaalp C, Yilmaz S, , 2015. Living donor liver transplantation for Echinococcus alveolaris: single-center experience. Liver Transpl 21: 10911095.[Crossref] [Google Scholar]
  15. Kawamura N, Kamiyama T, Sato N, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Yamaga S, Matsushita M, Todo S, , 2011. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience. J Am Coll Surg 212: 804812.[Crossref] [Google Scholar]
  16. Dulger AC, Esen R, Begenik H, Aytemiz E, Demirtas L, Aslan M, , 2012. Alveolar echinococcosis of the liver: a single center experience. Pol Arch Med Wewn 122: 133138. [Google Scholar]
  17. Qin Y, Li X, Zhang Q, Xie B, Ji X, Li Y, Yiblayan A, Wen H, , 2016. Analysis of the clinical value of F-FDG PET/CT in hepatic alveolar echinococcosis before and after autologous liver transplantation. Exp Ther Med 11: 4348. [Google Scholar]
  18. Li H, Song T, Qin Y, Liu W, Li X, Shao Y, Wen H, , 2015. Efficiency of liposomal albendazole for the treatment of the patients with complex alveolar echinococcosis: a comparative analysis of CEUS, CT, and PET/CT. Parasitol Res 114: 41754180.[Crossref] [Google Scholar]
  19. Graeter T, Kratzer W, Oeztuerk S, Haenle MM, Mason RA, Hillenbrand A, Kull T, Barth TF, Kern P, Gruener B, , 2016. Proposal of a computed tomography classification for hepatic alveolar echinococcosis. World J Gastroenterol 22: 36213631.[Crossref] [Google Scholar]
  20. Becce F, Pomoni A, Uldry E, Halkic N, Yan P, Meuli R, Schmidt S, , 2014. Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 83: 625631.[Crossref] [Google Scholar]
  21. Yang G, Zhang Q, Tang G, Xu H, Yang Z, Guo J, Liang L, Qi Y, , 2015. Role of magnetic resonance spectroscopy and susceptibility weighted imaging in cerebral alveolar echinococcosis. Iran J Parasitol 10: 122127. [Google Scholar]
  22. Kern P, Wen H, Sato N, Vuitton DA, Gruener B, Shao Y, Delabrousse E, Kratzer W, Bresson-Hadni S, , 2006. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int 55 (Suppl): S283S287.[Crossref] [Google Scholar]
  23. Brunetti E, Kern P, Vuitton DA, , 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114: 116.[Crossref] [Google Scholar]
  24. Bresson-Hadni S, Koch S, Beurton I, Vuitton DA, Bartholomot B, Hrusovsky S, Heyd B, Lenys D, Minello A, Becker MC, Vanlemmens C, Mantion GA, Miguet JP, , 1999. Primary disease recurrence after liver transplantation for alveolar echinococcosis: long-term evaluation in 15 patients. Hepatology 30: 857864.[Crossref] [Google Scholar]
  25. Bresson-Hadni S, Blagosklonov O, Knapp J, Grenouillet F, Sako Y, Delabrousse E, Brientini MP, Richou C, Minello A, Antonino AT, Gillet M, Ito A, Mantion GA, Vuitton DA, , 2011. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl 17: 855865.[Crossref] [Google Scholar]
  26. Pang C, Chu YK, , 2015. Recurrence of liver transplantation combined with lung and diaphragm resection for alveolar echinococcosis: a case report. Transplant Proc 47: 22782281.[Crossref] [Google Scholar]
  27. Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E, , 2008. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 12: 867871.[Crossref] [Google Scholar]
  28. Liu YH, Wang XG, Gao JS, Qingyao Y, Horton J, , 2009. Continuous albendazole therapy in alveolar echinococcosis: long-term follow-up observation of 20 cases. Trans R Soc Trop Med Hyg 103: 768778.[Crossref] [Google Scholar]
  29. Ammann RW, Stumpe KD, Grimm F, Deplazes P, Huber S, Bertogg K, Fischer DR, Mullhaupt B, , 2015. Outcome after discontinuing long-term benzimidazole treatment in 11 patients with non-resectable alveolar echinococcosis with negative FDG-PET/CT and anti-EmII/3-10 serology. PLoS Negl Trop Dis 9: e0003964.[Crossref] [Google Scholar]
  30. Davis A, Dixon H, Pawlowski ZS, , 1989. Multicentre clinical trials of benzimidazole-carbamates in human cystic echinococcosis (phase 2). Bull World Health Organ 67: 503508. [Google Scholar]
  31. Kern P, , 2010. Clinical features and treatment of alveolar echinococcosis. Curr Opin Infect Dis 23: 505512.[Crossref] [Google Scholar]
  32. Chomicz L, Szubert A, Fiedor P, Stefaniak J, Myjak P, Zbrowska J, Polanski JA, , 2003. Human cystic and alveolar echinococcoses as indication to liver transplantation. Transplant Proc 35: 22602261.[Crossref] [Google Scholar]
  33. Bresson-Hadni S, Franza A, Miguet JP, Vuitton DA, Lenys D, Monnet E, Landecy G, Paintaud G, Rohmer P, Becker MC, Christophe JL, Mantion G, Gillet M, , 1991. Orthotopic liver transplantation for incurable alveolar echinococcosis of the liver: report of 17 cases. Hepatology 13: 10611070.[Crossref] [Google Scholar]
  34. Koch S, Bresson-Hadni S, Miguet JP, Crumbach JP, Gillet M, Mantion GA, Heyd B, Vuitton DA, Minello A, Kurtz S, , 2003. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation 75: 856863.[Crossref] [Google Scholar]
  35. Li F, Yang M, Li B, Yan L, Zen Y, Wen T, Zao J, , 2007. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl 13: 924926.[Crossref] [Google Scholar]
  36. Haider HH, Nishida S, Selvaggi G, Levi D, Tekin A, Moon JI, Tzakis AG, , 2008. Alveolar echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant 22: 664667.[Crossref] [Google Scholar]
  37. Wen H, Dong JH, Zhang JH, Duan WD, Zhao JM, Liang YR, Shao YM, Ji XW, Tai QW, Li T, Gu H, Tuxun T, He YB, Huang JF, , 2016. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant 16: 615624.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 07 Jul 2016
  • Accepted : 18 Nov 2016
  • Published online : 09 Jan 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error