BACKGROUND: The World Health Organization guidelines recommend radical hepatic resection for definite treatment of alveolar echinococcosis (AE), because it can cure the patient. However, parasitic masses are not entirely removable in about 70% of patients. Even so, palliative resections are carried out, although cure cannot be achieved. As conservative treatment has improved, the role of palliative surgical procedures has to be redefined. METHODS: Critical appraisal of published reports on palliative resections for AE and estimation of the level of evidence and grade of recommendation. RESULTS: Prospective randomized trials comparing palliative resections, radical resections, and conservative treatment are lacking. Most papers analyzed case series retrospectively. The number of palliative operations is significant. In the past, palliative resections were recommended in order to enhance anthelminthic drug efficacy but advances in conservative and interventional treatment improved the prognosis of AE. Prolonged survival by systematic palliative resections is not evident. However, palliative surgery is an option to treat persistent bacterial infection, fistulas, and obstructing or compressing masses. The indication is based on individual considerations and decisions. CONCLUSION: Curative surgery for AE is feasible if parasitic tissue is entirely removable. The benefit of palliative resections is uncertain because long-term results of conservative treatment are favorable. Palliative surgery is an option for complications not being manageable otherwise.
BACKGROUND: The World Health Organization guidelines recommend radical hepatic resection for definite treatment of alveolar echinococcosis (AE), because it can cure the patient. However, parasitic masses are not entirely removable in about 70% of patients. Even so, palliative resections are carried out, although cure cannot be achieved. As conservative treatment has improved, the role of palliative surgical procedures has to be redefined. METHODS: Critical appraisal of published reports on palliative resections for AE and estimation of the level of evidence and grade of recommendation. RESULTS: Prospective randomized trials comparing palliative resections, radical resections, and conservative treatment are lacking. Most papers analyzed case series retrospectively. The number of palliative operations is significant. In the past, palliative resections were recommended in order to enhance anthelminthic drug efficacy but advances in conservative and interventional treatment improved the prognosis of AE. Prolonged survival by systematic palliative resections is not evident. However, palliative surgery is an option to treat persistent bacterial infection, fistulas, and obstructing or compressing masses. The indication is based on individual considerations and decisions. CONCLUSION: Curative surgery for AE is feasible if parasitic tissue is entirely removable. The benefit of palliative resections is uncertain because long-term results of conservative treatment are favorable. Palliative surgery is an option for complications not being manageable otherwise.
Authors: S Bresson-Hadni; P Humbert; G Paintaud; H Auer; D Lenys; R Laurent; D A Vuitton; J P Miguet Journal: J Am Acad Dermatol Date: 1996-05 Impact factor: 11.527
Authors: Andreas Hillenbrand; Beate Gruener; Wolfgang Kratzer; Peter Kern; Tilmann Graeter; Thomas F Barth; Klaus Buttenschoen; Doris Henne-Bruns Journal: World J Surg Date: 2017-04 Impact factor: 3.352
Authors: Balázs Dezsényi; Zsolt Dubóczki; Tamás Strausz; Eszter Csulak; Veronika Czoma; Zsolt Káposztás; Mária Fehérvári; Áron Somorácz; András Csilek; Attila Oláh; Kálmán Almási; Attila Patonai; Dénes Görög; Zoltán Széll; Zoltán Tolnai; Tamás Sréter; József Danka; Herbert Auer; Beate Grüner; Thomas F E Barth; Adriano Casulli Journal: BMC Infect Dis Date: 2021-02-10 Impact factor: 3.090