Relationship Between the Level of Anatomical Risk of Hepatic Alveolar Echinococcosis and Complications after Radical Resection

ZHI Ming, PANG Hua-sheng, WANG Wen-tao

Abstract

To analyze the impact of high or low levels of anatomical risk of hepatic alveolar echinococcosis (HAE) on complications after radical resection.   Methods  The baseline, surgical, and complication data were retrospectively collected from hepatic alveolar echinococcosis patients who underwent radical resection at the Ganzi Branch Hospital, West China Hospital, Sichuan University from 2015 to 2022. The patients were divided into anatomical low-risk (ALR) and anatomical high-risk (AHR) groups based on the PNM staging system designed by the World Health Organization (WHO-PNM). Complications were analyzed according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to assess the effect of high and low risks of lesion anatomy on complications.   Results  Radical surgery was performed in 216 HAE patients and 102 of whom were in the AHR group. The median operative time was 230 (175, 300) min, the median intraoperative blood loss was 600 mL, and 129 (59.7%) patients developed complications. The complication rate was 73.5% (75/102) in the AHR group and 47.4% (54/114) in the ALR group, demonstrating statistically significant difference (P<0.05). The incidence of serious complications was 36.3% (37/102) in the AHR group and 13.2% (15/114) in the ALR group, demonstrating statistically significant difference (P<0.05). There was significant difference in the proportions of patients having postoperative complications of bile leak, anemia, fever, pleural effusion and ascites between the AHR group and the ALR group (P<0.05). Multivariate logistic regression analysis suggested that AHR was the only independent risk factor for complications, including bile leak, anemia, fever, and pleural effusion, and severe complications.   Conclusion  The anatomical risk of hepatic alveolar echinococcosis is independently associated with the development of multiple postoperative complications, and physicians should choose surgical procedures cautiously according to the actual situation when dealing with patients defined as AHR according to WHO-PNM.

 

Keywords: Hepatic alveolar echinococcosis, Anatomy, Radical resection, Post operative complications

 

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References


BRESSON-HADNI S， SPAHR L， CHAPPUIS F， et al. Hepatic alveolar echinococcosis. Semin Liver Dis，2021，41(3): 393–408.

MCMANUS D P， ZHANG W， LI J， et al. Echinococcosis. Lancet，2003， 362(9392): 1295–1304.

BRUNETTI E， KERN P， VUITTON D A. Writing panel for the W-I. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop，2010，114(1): 1–16.

KERN P， WEN H， SATO N， et al. WHO classification of alveolar echinococcosis: Principles and application. Parasitol Int，2006，55 Suppl: S283–S287.

CLAVIEN P A， BARKUN J， DE OLIVEIRA M L， et al. The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg，2009，250(2): 187–196.

HASHIMOTO D， MIZUMA M， KUMAMARU H， et al. Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database. Br J Surg，2020，107(6): 734–742.

ZAWISTOWSKI M， NOWACZYK J， JAKUBCZYK M， et al. Outcomes of ex vivo liver resection and autotransplantation: A systematic review and meta-analysis. Surgery，2020，168(4): 631–642.

JIN S， FU Q， WUYUN G， et al. Management of post-hepatectomy complications. World J Gastroenterol，2013，19(44): 7983–7991.

YANG X， QIU Y， HUANG B， et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant， 2018，18(7): 1668–1679.

HE W， WANG L Y， YU W J， et al. Prevalence and spatial distribution patterns of human echinococcosis at the township level in Sichuan Province, China. Infect Dis Poverty，2021，10(1): 82.

YOSHIOKA R， SAIURA A， KOGA R， et al. Predictive factors for bile leakage after hepatectomy: Analysis of 505 consecutive patients. World J Surg，2011，35(8): 1898–1903.

DHIR M， SAMSON K K， YEPURI N， et al. Preoperative nomogram to predict posthepatectomy liver failure. J Surg Oncol，2021，123(8): 1750–1756.

RAHBARI N N， GARDEN O J， PADBURY R， et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery，2011，149(5): 713–724.

ARITA J， SAKAMAKI K， SAIURA A， et al. Drain placement after uncomplicated hepatic resection increases severe postoperative complication rate: A Japanese multi-institutional randomized controlled trial (ND-trial). Ann Surg，2021，273(2): 224–231.

BRESSAN A K， ISHERWOOD S， BATHE O F， et al. Preoperative single-dose methylprednisolone prevents surgical site infections after major liver resection: A randomized controlled trial. Ann Surg，2022， 275(2): 281–287.

JOHNSON P J， BERHANE S， KAGEBAYASHI C， et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade. J Clin Oncol，2015，33(6): 550–558.

WANG T， YANG X， WANG W， et al. A new sarcopenia score prognostic for postoperative complications in hepatic alveolar echinococcosis: A multicenter retrospective study. Ann Transl Med， 2020，8(21): 1398.

QIU Y， YAN， SHEN S， et al. Vascular infiltration-based surgical planning in treating end-stage hepatic alveolar echinococcosis with ex vivo liver resection and autotransplantation. Surgery，2019，165(5): 889–896.


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