Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases

Bo Qu Department of General Surgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China.

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Long Guo Department of Hepatobiliary Surgery, Liver Transplantation Center, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, People's Republic of China.

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Guannan Sheng Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China.

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Fei Yu Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China.

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Guannan Chen Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China.

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Yupeng Wang Department of Oncology, Tianjin Beichen Hospital, Tianjin, People's Republic of China.

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Yuan Shi Department of Hepatobiliary Surgery, Organ Transplantation Center, Tianjin First Center Hospital, Tianjin, People's Republic of China.

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Hanxiang Zhan Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.

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Yi Yang Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.

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Xiaoyan Du Department of Hematology, Peking University Third Hospital, Peking University, Beijing, People's Republic of China.

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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 (N = 15), palliative nonresective procedures (N = 13), OLT (N = 3), or albendazole therapy alone (N = 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.

Author Notes

* Address correspondence to Bo Qu, Department of General Surgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Logistics University of Chinese People's Armed Police Forces, Tianjin 300162, People's Republic of China. E-mail: doctor_qb@163.com
† These authors contributed equally to this work.

Financial support: This work was supported by the National Natural Science Foundation of China (no. 81272547).

Authors' addresses: Bo Qu, Fei Yu, Guannan Sheng, and Guannan Chen, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China, E-mails: doctor_qb@163.com, sheng_guan_nan@163.com, doctor_yuf@126.com, and 419452621@qq.com. Long Guo, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, People's Republic of China, E-mail: holydragon@hotmail.com. Yupeng Wang, Tianjin Beichen Hospital, Tianjin, People's Republic of China, E-mail: wyup216216@163.com. Yuan Shi, Tianjin First Center Hospital, Tianjin, People's Republic of China, E-mail: doctorshiyuan@163.com. Hanxiang Zhan, Qilu Hospital of Shandong University, Jinan, People's Republic of China, E-mail: hxzhanganbaochong@163.com. Yi Yang, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China, E-mail: yyangganbaochong@163.com. Xiaoyan Du, Peking University Third Hospital, Peking University, Beijing, People's Republic of China, E-mail: duxiaoyan7@163.com.

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