Abstract
Background: Alveolar echinococcosis (AE) is a significant health concern worldwide, primarily affecting the liver. The standard treatment of surgical removal faces significant challenges due to the complex nature of AE. Despite advancements in pharmacological treatments, surgery complemented by at least 2 years of adjuvant medical treatment post-surgery remains the primary curative approach for AE. Summary: The introduction of minimally invasive techniques, such as laparoscopic and robot-assisted surgery, has expanded surgical options, offering reduced recovery times and minimized surgical trauma while maintaining efficacy and safety comparable to traditional open surgery. Robotic surgery, known for its enhanced precision and visualization, emerges as a preferable method for complex resections in AE treatment, despite challenges such as high costs and the need for specialized training. Key Messages: The decision on the surgical approach is influenced by several factors, including parasite size, patient health, and technology availability. However, there is a clear preference for robotic procedures for their potential to offer better outcomes, though long-term data on outcomes and recurrence rates are needed. The treatment of AE, therefore, underscores the importance of an interdisciplinary approach and the advantages of minimally invasive surgery, advocating for its application in high-volume centers to optimize patient outcomes.
Journal Section:
Review Article
References
1.
Brunetti
E
, Kern
P
, Vuitton
DA
; Writing Panel for the WHO-IWGE
. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans
. Acta Trop
. 2010
;114
:1
–16
. 2.
Wen
H
, Dong
J-H
, Zhang
J-H
, Duan
W-D
, Zhao
J-M
, Liang
Y-R
, et al. Ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series
. Am J Transpl
. 2016
;16
(2
):615
–24
. 3.
Torgerson
PR
, Keller
K
, Magnotta
M
, Ragland
N
. The global burden of alveolar echinococcosis
. PLoS Negl Trop Dis
. 2010
;4
(6
):e722
. 4.
Wang
X
, Dai
G
, Li
M
, Jia
W
, Guo
Z
, Lu
J
. Prevalence of human alveolar echinococcosis in China: a systematic review and meta-analysis
. 2020
.5.
Wen
H
, Shao
Y
, Aji
T
, Zhao
J
, Mantion
G
, Tuxun
T
. Auto-transplantation hépatique après résection ex-vivo pour échinococcose alvéolaire au stade terminal
. Bull L’Académie Nationale Médecine
. 2019
;203
(1–2
):87
–93
. 6.
Wen
H
, Vuitton
L
, Tuxun
T
, Li
J
, Vuitton
DA
, Zhang
W
, et al. Echinococcosis: advances in the 21st century
. Clin Microbiol Rev
. 2019
;32
(2
):e00075-18
. 7.
McManus
DP
, Gray
DJ
, Zhang
W
, Yang
Y
. Diagnosis, treatment, and management of echinococcosis
. BMJ
. 2012
;344
:e3866
. 8.
Emmen
AMLH
, Görgec
B
, Zwart
MJW
, Daams
F
, Erdmann
J
, Festen
S
, et al. Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections
. Surg Endosc
. 2023
;37
(4
):2659
–72
. 9.
Farrarons
SS
, van Bodegraven
EA
, Sauvanet
A
, Hilal
MA
, Besselink
MG
, Dokmak
S
. Minimally invasive versus open central pancreatectomy: systematic review and meta-analysis
. Surgery
. 2022
;172
(5
):1490
–501
. 10.
Chin
KM
, Chua
DWQ
, Lee
SY
, Chan
CY
, Goh
BKP
. Outcome of minimally invasive liver resection for extrapancreatic biliary malignancies: a single-institutional experience
. J Minim Access Surg
. 2021
;17
(1
):69
–75
. 11.
Birgin
E
, Abdelhadi
S
, Seyfried
S
, Rasbach
E
, Rahbari
M
, Téoule
P
, et al. Robotic or laparoscopic repeat hepatectomy after open hepatectomy: a cohort study
. Surg Endosc
. 2024
;38
(3
):1296
–305
. 12.
Birgin
E
, Kaslow
SR
, Hetjens
S
, Correa-Gallego
C
, Rahbari
NN
. Minimally invasive versus open liver resection for stage I/II hepatocellular carcinoma
. Cancers
. 2021
;13
(19
):4800
. 13.
Birgin
E
, Heibel
M
, Hetjens
S
, Rasbach
E
, Reissfelder
C
, Téoule
P
, et al. Robotic versus laparoscopic hepatectomy for liver malignancies (ROC’N’ROLL): a single-centre, randomised, controlled, single-blinded clinical trial
. Lancet Reg Health Eur
. 2024
;43
:100972
. 14.
Wan
L
, Ran
B
, Aji
T
, Shao
Y
, Jiang
T
, Wen
H
. Laparoscopic or open treatment for hepatic alveolar echinococcosis: a single-institution experience
. Int J Infect Dis
. 2021
;107
:182
–7
. 15.
Salm
LA
, Lachenmayer
A
, Perrodin
SF
, Candinas
D
, Beldi
G
. Surgical treatment strategies for hepatic alveolar echinococcosis
. Food Waterborne Parasitol
. 2019
;15
:e00050
. 16.
Birgin
E
, Hartwig
V
, Rasbach
E
, Seyfried
S
, Rahbari
M
, Reeg
A
, et al. Minimally invasive mesohepatectomy for centrally located liver lesions—a case series
. Surg Endosc
. 2022
;36
(12
):8935
–42
. 17.
Grüner
B
, Kern
P
, Mayer
B
, Gräter
T
, Hillenbrand
A
, Barth
TEF
, et al. Comprehensive diagnosis and treatment of alveolar echinococcosis: a single-center, long-term observational study of 312 patients in Germany
. GMS Infect Dis
. 2017
;5
:Doc01
. 18.
Kern
P
, Wen
H
, Sato
N
, Vuitton
DA
, Gruener
B
, Shao
Y
, et al. WHO classification of alveolar echinococcosis: principles and application
. Parasitol Int
. 2006
;55
(Suppl l
):S283
–7
. 19.
Schmidberger
J
, Kratzer
W
, Stark
K
, Grüner
B
; Echinococcosis Working Group
. Alveolar echinococcosis in Germany, 1992–2016. An update based on the newly established national AE database
. Infection
. 2018
;46
(2
):197
–206
. 20.
Burkert
S
, Peters
L
, Bloehdorn
J
, Grüner
B
. Salvage therapy for alveolar echinococcosis—a case series
. Pathogens
. 2022
;11
(3
):333
. 21.
Husmann
L
, Gruenig
H
, Reiner
CS
, Deibel
A
, Ledergerber
B
, Liberini
V
, et al. Prediction of benzimidazole therapy duration with PET/CT in inoperable patients with alveolar echinococcosis
. Sci Rep
. 2022
;12
(1
):11392
. 22.
Peters
L
, Jiang
W
, Eberhardt
N
, Hagemann
JB
, Grüner
B
, Tappe
D
. 18FDG-PET/CT-Scans and biomarker levels predicting clinical outcome in patients with alveolar echinococcosis—a single-center cohort study with 179 patients
. Pathogens
. 2023
;12
(8
):1041
. 23.
Hotz
JF
, Peters
L
, Kapp-Schwörer
S
, Theis
F
, Eberhardt
N
, Essig
A
, et al. Evaluation of serological markers in alveolar echinococcosis emphasizing the correlation of PET-CTI tracer uptake with RecEm18 and echinococcus-specific IgG
. Pathogens
. 2022
;11
(2
):239
. 24.
Dulundu
E
. Management of hepatic echinococcal disease and its complications
; 2020
. p. 129
–41
.25.
Chen
K
, Tang
Y
, Wang
R
, Fang
D
, Chen
J-H
, Zeng
Y
, et al. The choose of different surgical therapies of hepatic alveolar echinococcosis: a single-center retrospective case-control study
. Medicine
. 2018
;97
(8
):e0033
. 26.
Joliat
GR
, Melloul
E
, Petermann
D
, Demartines
N
, Gillet
M
, Uldry
E
, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study
. World J Surg
. 2015
;39
(10
):2529
–34
. 27.
Gloor
S
, Candinas
D
, Beldi
G
, Lachenmayer
A
. Laparoscopic resection of hepatic alveolar echinococcosis: a single-center experience
. PLoS Negl Trop Dis
. 2022
;16
(9
):e0010708
. 28.
Aliakbarian
M
, Tohidinezhad
F
, Eslami
S
, Akhavan-Rezayat
K
. Liver transplantation for hepatic alveolar echinococcosis: literature review and three new cases
. Infect Dis
. 2018
;50
(6
):452
–9
. 29.
Buttenschoen
K
, Carli Buttenschoen
D
, Gruener
B
, Kern
P
, Beger
HG
, Henne-Bruns
D
, et al. Long-term experience on surgical treatment of alveolar echinococcosis
. Langenbeck’s Arch Surg
. 2008
;394
(4
):689
–98
. 30.
Hillenbrand
A
, Gruener
B
, Kratzer
W
, Kern
P
, Graeter
T
, Barth
TF
, et al. Impact of safe distance on long-term outcome after surgical therapy of alveolar echinococcosis
. World J Surg
. 2017
;41
(4
):1012
–8
. 31.
Li
SQ
, Huang
T
, Shen
SL
, Hua
YP
, Hu
WJ
, Kuang
M
, et al. Anatomical versus non‐anatomical liver resection for hepatocellular carcinoma exceeding Milan criteria
. Br J Surg
. 2017
;104
(1
):118
–27
. 32.
Lachenmayer
A
, Gebbers
D
, Gottstein
B
, Candinas
D
, Beldi
G
. Elevated incidence of alveolar echinococcosis in immunocompromised patients
. Food Waterborne Parasitol
. 2019
;16
:e00060
. 33.
Kawamura
N
, Kamiyama
T
, Sato
N
, Nakanishi
K
, Yokoo
H
, Kamachi
H
, et al. Long-term results of hepatectomy for patients with alveolar echinococcosis: a single-center experience
. J Am Coll Surg
. 2011
;212
(5
):804
–12
. 34.
Beldi
G
, Vuitton
D
, Lachenmayer
A
, Heyd
B
, Dufour
J-F
, Richou
C
, et al. Is ex vivo liver resection and autotransplantation a valid alternative treatment for end-stage hepatic alveolar echinococcosis in Europe
. J Hepatol
. 2019
;70
(5
):1030
–1
. 35.
Gloor
S
, Jiang
W
, Maurer
MH
, Gottstein
B
, Oberli
A
, Hagemann
JB
, et al. The trajectory of anti-recEm18 antibody levels determines follow-up after curative resection of hepatic alveolar echinococcosis
. HPB
. 2024
;26
(2
):224
–33
. 36.
Svilenov
D
, Heymer
B
, Haferkamp
O
. Immunomorphology and pathogenesis of echinococcosis. III: microscopic immunofluorescence studies in experimental alveolar echinococcosis
. Infection
. 1978
;6
(1
):12
–5
. 37.
Bardonnet
K
, Vuitton
DA
, Grenouillet
F
, Mantion
GA
, Delabrousse
E
, Blagosklonov
O
, et al. 30-yr course and favorable outcome of alveolar echinococcosis despite multiple metastatic organ involvement in a non-immune suppressed patient
. Ann Clin Microbiol Antimicrob
. 2013
;12
:1
. 38.
Steinkraus
KC
, Jötten
L
, Traub
B
, Zaimi
M
, Denzinger
M
, Michalski
CW
, et al. Robotic liver surgery for alveolar echinococcosis: a single-centre experience
. Pathogens
. 2022
;11
:1276
. 39.
Birgin
E
, Reißfelder
C
, Rahbari
NN
. Robot with the scissorhands: scissor hepatectomy for parenchymal transection in robotic liver resection
. J Gastrointest Surg
. 2024
;28
(1
):99
–101
. 40.
Kamiyama
T
, Nakanishi
K
, Yokoo
H
, Kamachi
H
, Tahara
M
, Yamashita
K
, et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution
. J Am Coll Surg
. 2010
;211
(4
):443
–9
. 41.
Reuter
S
, Jensen
B
, Buttenschoen
K
, Kratzer
W
, Kern
P
. Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature
. J Antimicrob Chemother
. 2000
;46
(3
):451
–6
. 42.
Machairas
N
, Papaconstantinou
D
, Tsilimigras
DI
, Moris
D
, Prodromidou
A
, Paspala
A
, et al. Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes
. Updat Surg
. 2019
;71
(1
):39
–48
. 43.
Schmelzle
M
, Feldbrügge
L
, Ortiz Galindo
SA
, Moosburner
S
, Kästner
A
, Krenzien
F
, et al. Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years
. Surg Endosc
. 2022
;36
(8
):5854
–62
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