Right Liver Resection Techniques for Advanced Alveolar Echinococcosis with Vascular Invasion

The aim of the investigation was to analyze the techniques and results of right liver resections with vascular resections and reconstructions in advanced hepatic alveolar echinococcosis.

Material and Methods. The retrospective study included 12 patients with advanced alveolar echinococcosis of the right part of the liver and parasitic invasion of portal vein bifurcation, and/or inferior vena cava, and/or hepatic veins confluence. The mean age was 47.6±18.3 years (from 21 to 65 years, median 57). Extended right hemihepatectomy (Sg4–8) was performed in 10 (83.3%) cases, right hemihepatectomy (Sg5–8) in 2 (16.7%) cases. Sg1 was removed in 11 cases, additional nonanatomic resection of Sg2 and Sg3 was performed in 1 case. Normothermic resection was used in 10 patients, in vivo in situ hypothermic perfusion in 1 patient, and ex vivo resection in 1 patient. Arterial resection was necessary in 2 cases, portal vein resection in 9 cases, inferior vena cava resection in 8 cases. Inferior vena cava was reconstructed with a ePTFE-graft (1 case), autogenous vein graft (2), anastomosis (2), or by caval plasty (3).

Results. Hospital mortality was absent. Surgical complications (Grade IIIb–IVa, Clavien–Dindo) were observed in 5 cases, bile leakage (Grade C, ISGLS) in 2 cases. There were no vascular complications and post-hepatectomy liver failure. The patients stayed in the intensive care unit for 9.0±8.5 days (from 3 to 34 days, median 6) and total length of hospital stay was for 34.0±16.1 days on average (from 13 to 70 days, median 33). During 19-month median follow-up there was no recurrence of the disease.

Conclusion. Liver resection is the preferred treatment option and is feasible in the majority of patients with advanced alveolar echinococcosis in the absence of unresectable distant metastases, liver cirrhosis, Budd–Chiari syndrome and in the presence of technical possibility to preserve or reconstruct afferent and efferent blood circulation in the remnant liver.

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Porshennikov I.A. Right Liver Resection Techniques for Advanced Alveolar Echinococcosis with Vascular Invasion. Sovremennye tehnologii v medicine 2017; 9(1): 44, https://doi.org/10.17691/stm2017.9.1.05