Evolution of surgical treatment for hepatic cystic echinococcosis over forty years' experience in an endemic area

BACKGROUND: Hepatic cystic echinococcosis (CE) represents an important public health problem with different treatment modalities. The purpose of this study was to retrospectively analyze the evolution of different surgical procedures and to compare clinical outcome between conservative and radical surgery for CE in an endemic area over forty years' experience. METHODS: From January 1970 to December 2011, data were collected on two different time periods (1970-1990, 1991-2011), including patient age, sex, characteristics of liver hydatid cysts, clinical presentation, diagnostic methods, surgical treatment, complications, mortality, recurrences and follow-up. RESULTS: A total of 312 patients had undergone surgery for liver hydatid cysts. The mean age was 63.3 years (range 7-80 years) with 161 males and 151 females. The main clinical presentation was abdominal pain in 83.3% of patients. In 70.1% of cases the cysts were located in the right lobe. A progressive reduction of conservative surgery as opposed to radical approaches was observed in the different periods. An increase of total pericystectomy and, in the last period (1991-2011), of partial pericystectomy approaches were observed, together with a decrease of marsupialization, partial cystectomy and hepatic resection. As regards to postoperative complications, it was noted an important reduction of major postoperative complications, such as biliary leakage, especially in radical surgery group, even if differences were not statistically significant. There was a statistically significant relationship between wound infection and fever and the type of surgery in favour of radical procedures (P<0.0001 and P<0.0002, respectively). No statistically significant differences in recurrence rates were observed during the time period. CONCLUSIONS: Surgical treatment for CE has changed over the years in the current analysis. According to our experience, surgery represents a safe and effective therapeutic modality in terms of recurrence rates and morbidity.