Email this article The results of surgical treatment in patients with liver alveococcosis in a hepato-pancreato-biliary center (a 10-years’ experience)
- Authors: Kiselev N.M.1,2, Gorokhov G.G.2, Belskiy V.A.2, Bobrov N.A.1,2, Mukhanzaev S.K.3, Zagainov V.E.1,2
-
Affiliations:
- Privolzhsky Research Medical University
- Volga District Medical Centre
- State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
- Issue: Vol 46, No 6 (2018)
- Pages: 609-617
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/900
- DOI: https://doi.org/10.18786/20720505-2018-46-6-609-617
- ID: 900
Cite item
Full Text
Abstract
Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.
Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.
Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.
Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.
Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.
About the authors
N. M. Kiselev
Privolzhsky Research Medical University; Volga District Medical Centre
Author for correspondence.
Email: kiselev_1989@mail.ru
Nikolay M. Kiselev – MD, Assistant, Chair of Faculty Surgery and Transplantology PRMU; Surgeon, Department of Oncology, Clinical Hospital No 1 VDMC.
14 Il'inskaya ul., Nizhny Novgorod, 603109, tel.: +7 (910) 147 37 22
Russian FederationG. G. Gorokhov
Volga District Medical Centre
Email: fake@neicon.ru
Gleb G. Gorokhov – MD, Head of the Department of Oncology, Clinical Hospital No 1.
14 Il'inskaya ul., Nizhny Novgorod, 603109
Russian FederationV. A. Belskiy
Volga District Medical Centre
Email: fake@neicon.ru
Vladislav A. Belskiy – MD, Chief Specialist in Anesthesiology and Intensive Care.
14 Il'inskaya ul., Nizhny Novgorod, 603109
Russian FederationN. A. Bobrov
Privolzhsky Research Medical University; Volga District Medical Centre
Email: fake@neicon.ru
Nikolay V. Bobrov – MD, Assistant, Chair of Faculty Surgery and Transplantology PRMU; Surgeon, Department of Oncology, Clinical Hospital No 1 VDMC.
10/1 Minina i Pozharskogo ploshchad', Nizhny Novgorod, 603005
Russian FederationSh. Kh. Mukhanzaev
State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Email: fake@neicon.ru
Shamsudin Kh. Mukhanzaev – Postgraduate Student, Chair of Visiting and Innovative Education in Integrated Disciplines, Institute of Postgraduate Professional Education.
23 Marshala Novikova ul., Moscow, 123098
Russian FederationV. E. Zagainov
Privolzhsky Research Medical University; Volga District Medical Centre
Email: fake@neicon.ru
Vladimir E. Zagainov – MD, PhD, Head of the Chair of Faculty Surgery and Transplantology PRMU; Chief Specialist in Surgery VDMC.
10/1 Minina i Pozharskogo ploshchad', Nizhny Novgorod, 603005
Russian FederationReferences
- Thomas MN, Zwingelberg S, Angele M, Guba M, Werner J. Diagnosis and treatment of cystic and alveolar echinococcosis. MMW Fortschr Med. 2017;159(14): 38–42. doi: 10.1007/s15006-017-9948-z.
- Chen KF, Tang YY, Wang R, Fang D, Chen JH, Zeng Y, Li B, Wen TF, Wang WT, Wu H, Xu MQ, Yang JY, Wei YG, Huang JW, Li JX, Zhang HZ, Feng X, Yan LN, Chen ZY. The choose of different surgical therapies of hepatic alveolar echinococcosis: A single-center retrospective case-control study. Medicine (Baltimore). 2018;97(8):e0033. doi: 10.1097/MD.0000000000010033.
- Восканян СЭ, Артемьев АИ, Найденов ЕВ, Забежинский ДА, Чучуев ЕС, Рудаков ВС, Шабалин МВ, Щербин ВВ. Трансплантационные технологии в хирургии местнораспространенного альвеококкоза печени с инвазией магистральных сосудов. Анналы хирургической гепатологии. 2016;21(2): 25–31. doi: 10.16931/19955464.2016225-31.
- Поршенников ИА, Быков АЮ, Павлик ВН, Карташов АС, Щекина ЕЕ, Юшина ЕГ, Коробейникова МА. Трансплантации и радикальные резекции печени с реконструкциями сосудов при распространенном альвеококкозе. Анналы хирургической гепатологии. 2016;21(2): 11–24. doi: 10.16931/1995-5464.2016211-24.
- Piarroux M, Piarroux R, Giorgi R, Knapp J, Bardonnet K, Sudre B, Watelet J, Dumortier J, Gérard A, Beytout J, Abergel A, Mantion G, Vuitton DA, Bresson-Hadni S. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: results of a survey in 387 patients. J Hepatol. 2011;55(5): 1025–33. doi: 10.1016/j.jhep.2011.02.018.
- Joliat GR, Melloul E, Petermann D, Demartines N, Gillet M, Uldry E, Halkic N. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study.World J Surg. 2015;39(10): 2529–34. doi: 10.1007/s00268-015-3109-2.
- Cambier A, Giot JB, Leonard P, Bletard N, Meunier P, Hustinx R, Delwaide J, Meurisse N, Honore P, Losson B, Hayette MP, Detry O. Multidisciplinary management of alveolar echinococcosis: Echino-Liege Working Group. Rev Med Liege. 2018;73(3): 135–42.
- Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114(1): 1–16. doi: 10.1016/j.actatropica.2009.11.001.
- Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5): 680–8. doi: 10.1016/j.surg.2010.12.002.
- Deplazes P, Rinaldi L, Alvarez Rojas CA, Torgerson PR, Harandi MF, Romig T, Antolova D, Schurer JM, Lahmar S, Cringoli G, Magambo J, Thompson RC, Jenkins EJ. Global distribution of alveolar and cystic echinococcosis. Adv Parasitol. 2017;95:315–493. doi: 10.1016/bs.apar.2016.11.001.
- Patkowski W, Kotulski M, Remiszewski P, Grąt M, Zieniewicz K, Kobryń K, Najnigier B, Ziarkiewicz-Wróblewska B, Krawczyk M. Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation. Transpl Infect Dis. 2016;18(5): 661–6. doi: 10.1111/tid.12574.
- Jianyong L, Jingcheng H, Wentao W, Lunan Y, Jichun Z, Bing H, Ding Y. Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review. Medicine (Baltimore). 2015;94(7):e514. doi: 10.1097/MD.0000000000000514.
- 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. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant. 2016;16(2): 615–24. doi: 10.1111/ajt.13465.
- Tuxun T, Aini A, Li YP, Apaer S, Zhang H, Li T, Aji T, Yimiti Y, Zhao JM, Shao YM, Wen H. Systematic review of feasibility, safety and efficacy of ex situ liver resection and autotransplantation. Zhonghua Yi Xue Za Zhi. 2016;96(28): 2251–7. doi: 10.3760/cma.j.issn.0376-2491.2016.28.011.
- Aydinli B, Ozturk G, Arslan S, Kantarci M, Tan O, Ahıskalioglu A, Özden K, Colak A. Liver transplantation for alveolar echinococcosis in an endemic region. Liver Transpl. 2015;21(8): 1096–102. doi: 10.1002/lt.24195.
- Hatipoglu S, Bulbuloglu B, Piskin T, Kayaalp C, Yilmaz S. Living donor liver transplantation for alveolar echinococcus is a difficult procedure. Transplant Proc. 2013;45(3): 1028–30. doi: 10.1016/j.transproceed.2013.02.084.
- Koch S, Bresson-Hadni S, Miguet JP, Crumbach JP, Gillet M, Mantion GA, Heyd B, Vuitton DA, Minello A, Kurtz S; European Collaborating Clinicians. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation. 2003;75(6): 856–63. doi: 10.1097/01.TP.0000054230.63568.79.
Supplementary files
