Surgery for Liver Cystic Echinococcosis: Risk Factors Related to the Risk of Complex Biliary Fistula and Hepatic Recurrence. Results of a Long-Term Cohort Study.

Abstract

The main objective was to compare the results of conservative surgery (CS) and radical surgery (RS)-defined as complete removal of all layers of the cyst-for the treatment of liver cystic echinococcosis (LCE). Patients who underwent surgery at our institution for LCE between 1996 and 2021 were retrospectively analyzed using a prospective registry. A comparative analysis between groups was performed, focusing on the evaluation of potential risk factors for hepatic recurrence (HR) and complex biliary fistula (BF). Among the 192 surgeries included, 66% underwent RS. Groups were homogeneous except for cyst diameter and contact with the inferior vena cava, hepatic vein, or diaphragm. CS was associated with a higher incidence of complex BF (16.9% vs. 6.3%, p = 0.02) and longer hospital stay (18 vs. 10.3 days, p = 0.002). Multivariate analysis showed that a residual pericyst layer in contact with portal pedicle was the main risk factor for complex BF (OR 21.57; p = 0.009). HR occurred more often in the CS group (15.6% vs. 1.6%, p < 0.001). Independent risks factors for HR included cyst diameter ≥ 10 cm, coexistent extrahepatic cysts, and residual pericyst layer ≥ 40%. Disease-free survival at 1, 3, and 5 years remained stable at each time point in the RS group (97.5%) but decreased with time in the CS group (94.5%, 67.4%, and 60.7% p = 0.005). Although surgery for LCE should be individualized, RS is preferable in cases with preoperative risk factors as it is associated with lower incidences of complex BF and HR.