Kamil Y Polat1, Ahmet A Balik, Fehmi Celebi. 1. Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey. yalcinp@hotmail.com
Abstract
OBJECTIVE: To review the clinical management of alveolar echinococcosis. DESIGN: A retrospective analysis. SETTING: A university-affiliated hospital in Turkey. PATIENTS: Forty patients treated for alveolar echinococcosis between 1987 and 2000. INTERVENTIONS: Curative resection followed by chemotherapy, or medical palliation with chemotherapy only. Palliative procedures such as bilioenteric or external drainage were done for cholestatic jaundice and liver abscess. OUTCOME MEASURES: Results of medical and surgical treatment. RESULTS: Seventeen patients had a resectable tumour and all underwent curative resection. Of the other 23 patients with nonresectable tumour, 11 underwent palliative surgical procedures such as bilioenteric or external drainage for cholestatic jaundice or liver abscess. All patients received long-term albendazole therapy. Four patients with nonresectable tumour died because of chronic liver failure. In a 6.5-year follow-up, there was no recurrence in patients who underwent curative resection. The efficacy of chemotherapy is limited in nonresectable disease. CONCLUSIONS: To increase the rate of early detection and curative resection, screening programs are essential. Research on new chemotherapeutic approaches should be made to improve survival in patients with nonresectable disease.
OBJECTIVE: To review the clinical management of alveolar echinococcosis. DESIGN: A retrospective analysis. SETTING: A university-affiliated hospital in Turkey. PATIENTS: Forty patients treated for alveolar echinococcosis between 1987 and 2000. INTERVENTIONS: Curative resection followed by chemotherapy, or medical palliation with chemotherapy only. Palliative procedures such as bilioenteric or external drainage were done for cholestatic jaundice and liver abscess. OUTCOME MEASURES: Results of medical and surgical treatment. RESULTS: Seventeen patients had a resectable tumour and all underwent curative resection. Of the other 23 patients with nonresectable tumour, 11 underwent palliative surgical procedures such as bilioenteric or external drainage for cholestatic jaundice or liver abscess. All patients received long-term albendazole therapy. Four patients with nonresectable tumour died because of chronic liver failure. In a 6.5-year follow-up, there was no recurrence in patients who underwent curative resection. The efficacy of chemotherapy is limited in nonresectable disease. CONCLUSIONS: To increase the rate of early detection and curative resection, screening programs are essential. Research on new chemotherapeutic approaches should be made to improve survival in patients with nonresectable disease.