What is the role of surgery in the treatment of alveolar echinococcosis (AE)?

Updated: May 07, 2019
  • Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD  more...
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Answer

Note the following:

  • Indications: The indication is resectability of the liver lesion (assessed by imaging techniques preoperatively).

  • Contraindications: These are inoperable lesions, extensive lesions, and lesions extending outside the liver and involving other organs.

  • Choice of surgical technique: Radical surgery with complete excision of the lesion is the only chance for cure. In certain cases, total hepatectomy with transplantation has been performed as long as no extra hepatic disease is present. Reemergence of the parasite in the transplanted liver and distant metastasis occur under immunosuppression. Partial resections of unresectable masses are considered to decrease the parasite load to aid the chemotherapeutic agents. [11] More recently, ex vivo liver resection combined with autotransplantation appears to show potential for curing end-stage hepatic alveolar echininococcosis in those with unresectable lesions. [12]

  • Medical requirements: Surgical staff experienced in major liver resections and medical staff experienced in the administration of chemotherapy to persons with AE are required. Perform liver transplantations in centers where a well-coordinated and experienced team is available.


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