Management of hepatic echinococcosis: Should surgical intervention be the first-line therapeutic option?
DOI:
https://doi.org/10.12923/2083-4829/2025-0004Keywords:
echinococcosis, treatment methods, treatment outcomes, surgery, Cystic Echinococcosis (CE)Abstract
Introduction. Echinococcosis is a serious zoonotic disease, especially in endemic regions. Its treatment remainsthe subject of debate,, including pharmacotherapy, percutaneous techniques, and surgery. Without intervention, mortality can reach 90%. Common symptoms include weight loss, right upper quadrant discomfort, and, less frequently, jaundice with cholangitis.
Materials and methods. This unsystematic literature review covers studies from PubMed and Google Scholar (2020-2025) focused on echinococcosis treatment. Keywords included: echinococcosis, treatment outcomes, diagnostic methods, surgery, cystic echinococcosis (CE).
Results. Thechoice of therapy depends of thedisease stage. The most effective strategy is radical surgical resection combined with benzimidazole-based therapy, which has a low recurrence rate. However, surgery carries risks such as bleeding, bile leakage, infections, and bowel obstruction. Despite these complications, it remains the gold standard, offering favorable long-term results. In cases with hydatid cyst abscess, non-radical surgery is preferred to reduce postoperative complications. Albendazole monotherapy is suitable only for lesions under 5 cm, extending 10-year survival in 80% of cases. Due to the long latency and nonspecific early symptoms, surgery is required in most cases.
Conclusions. Pharmacotherapy alone is rarely sufficient. Surgery remains the most effective approach, ensuring parasite removal and lowering recurrence risk. The best outcomes are achieved with a combined approach: initial albendazole therapy, followed by surgery after cyst shrinkage, and continued albendazole use postoperatively.
References
1. Lundström-Stadelmann B, Rostami A, Frey CF, et al. Human alveolar echinococcosis – global, regional, and national annual incidence and prevalence rates. Clin Microbiol Infect. 2025;31(7):1139-45.
2. Wen H, Vuitton L, Tuxun T, et al. Echinococcosis: progress in the 21st century. Clin Microbiol Rev. 2019;32(1):e00075-18.
3. Tao Y, Wang YF, Wang J, et al. Pictorial review of hepatic echinococcosis: ultrasound imaging and differential diagnosis. Clin Imaging. 2024. PMID: 39474399.
4. European Centre for Disease Prevention and Control. Echinococcosis. In: Annual Epidemio-logical Report for 2020. Stockholm: ECDC; 2022.
5. Respondek A, Baryła M, Popławska-Ferenc A, et al. Echinococcosis of the liver in Poland – review of the literature and our own clinical material. Clin Exp Hepatol. 2024;10(3):150-8.
6. Govindasamy A, Bhattarai PR, John J. Liver cystic echinococcosis: a parasitic review. Ther Adv Infect Dis. 2023;10:20499361231171478.
7. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zo-onosis of increasing concern. Clin Microbiol Rev. 2004;17(1):107-35.
8. Fadakar B, Tabatabaei N, Borji H, Naghibi A. Genotyping of Echinococcus granulosus from goats and sheep indicating G7 genotype in goats in the Northeast of Iran. Parasitol Res. 2015;114(5):1931-5.
9. Jia A, Chai JP, Jia SL, et l. Historical changes in surgical strategy and treatment of complica-tions in cystic liver echinococcosis. World J Gastrointest Surg. 2023;15(8):1591-9.
10. Haran JP, Koren O, Harel M, et al. Alzheimer’s disease patients have less butyrate-producing bacteria in their gut microbiome. Sci Rep. 2019;9(1):1-9.
11. Keong B, Wilkie B, Sutherland T, et al. Cystic echinococcosis of the liver in Australia: an up-date on diagnosis and treatment. ANZ J Surg. 2018;88(1-2):26-31.
12. Pavlidis ET, Symeonidis N, Psarras K, Pavlidis TE. Giant hydatid cyst of the liver treated by hepatectomy: report of two cases. Int J Surg Case Rep. 2017;31:79-82.
13. Hajjafari A, Sadr S, Santucci C, et al. Advances in detecting cystic echinococcosis in interme-diate hosts and new diagnostic tools: a literature review. Vet Sci. 2024;11(6):227.
14. Kakamad FH, Anwar KA, Ahmed HK, et al. Risk factors associated with human echinococ-cosis: a systematic review and meta-analysis. Front Vet Sci. 2024;11:1480579.
15. Pavlidis ET, Galanis IN, Pavlidis TE. Current considerations for the management of liver echi-nococcosis. World J Hepatol. 2024;16(7):645-58.
16. Gunjal PM, Schneider G, Ismail AA, et al. Evidence for induction of a tumor metastasis-receptive microenvironment for ovarian cancer cells in bone marrow and other organs as an unwanted and underestimated side effect of chemotherapy/radiotherapy. J Ovarian Res. 2015;8:41.
17. Sochocka M, Donskow-Łysoniewska K, Diniz BS, et al. The gut microbiome alterations and inflammation-driven pathogenesis of Alzheimer’s disease – a critical review. Mol Neurobiol. 2019;56(3):1841-51.
18. Wang J, Xie Y, Wu T, et al. Phytic acid alleviates ochratoxin A-induced renal damage in chicks by modulating ferroptosis and the structure of the intestinal microbiota. Poult Sci. 2024;103(9):104027.
19. Dai M, Yang X, Yu Y, Pan W. Helminth and host crosstalk: new insight into treatment of obe-sity and its associated metabolic syndromes. Front Immunol. 2022;13:827486.
20. Wencel PL, Blecharz-Klin K, Piechal A, et al. Fingolimod modulates the gene expression of proteins engaged in inflammation and amyloid-beta metabolism and improves exploratory and anxiety-like behavior in obese mice. Neurotherapeutics. 2023;20(5):1388-404.
21. Kulawiak N, Sulima M, Gesing M, et al. Practical aspects and treatment of unilocular echino-coccosis – current state of knowledge. Hepatol Pol. 2023;23:58-62.
22. Woolsey ID, Miller AL. Echinococcus granulosus sensu lato and Echinococcus multilocularis: a review. Res Vet Sci. 2021;135:517-22.
23. Bhutani N, Kajal P. Hepatic echinococcosis: a review. Ann Med Surg. 2018;36:99-105.
24. Stojković M, Weber TF, Junghanss T. Clinical treatment of cystic echinococcosis: current knowledge and perspectives. Curr Opin Infect Dis. 2018;31:383-92.
25. Lorenzo C, Ferreira HB, Monteiro KM, et al. Comparative analysis of six major Echinococcus granulosus antigens in a double-blind, randomized, multicenter diagnostic study. J Clin Mi-crobiol. 2005;43:2764-70.
26. Calame P, Weck M, Busse-Cote A, et al. The radiologist’s role in diagnosing and managing two forms of hepatic echinococcosis. Insights Imaging. 2022;13:68.
27. Rashid MM, Rabbi H, Ahmed AT, et al. Surgical outcomes of 79 patients with liver hydati-dosis: experience at a tertiary care hospital in Bangladesh. J Surg Sci. 2020;22:118-24.
28. Kern P, Menezes da Silva A, Akhan O, et al. Echinococcosis: diagnosis, clinical management and burden of disease. Adv Parasitol. 2017;96:259-369.
29. Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114(1):1-16.
30. Li T, Ito A, Chen X, Qiu J. Epidemiology of echinococcosis in China. Parasitol Int. 2022;91:102574.
31. Kawamura N, Kamiyama T, Sakamoto Y, et al. Clinical features and management of hepatic cystic echinococcosis: a single-center experience in Japan. Surg Today. 2019;49(6):516-22.
32. McManus DP, Gray DJ, Zhang W, Yang Y. Diagnosis, treatment, and management of echino-coccosis. BMJ. 2012;344:e3866.
33. Steinkraus KC, Etzold S, Reuter S, et al. Robotic liver surgery for alveolar echinococcosis: a single-centre experience. Pathogens. 2022;11(11):1276.
34. Kuscher S, Kronberger IE, Loizides A, et al. Exploring the limits of hepatic surgery for alveolar echinococcosis- 10-years’ experience in an endemic area of Austria. Eur Surg. 2019;51(4):189-96.
35. Tuxun T, Zhang JH, Zhao JM, et al. World review of laparoscopic treatment of liver cystic echinococcosis - 914 patients. Int J Infect Dis. 2014;24:43-50.
36. Joliat GR, Melloul E, Petermann D, et al. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg. 2015;39(8):2057-65.
37. World Health Organization. Guidelines on the prevention and treatment of hydatid disease. Geneva: WHO; 2020.
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