Options for Two-Stage Extensive Liver Resections in the Surgical Treatment of Advanced Liver Echinococcosis

Abstract

Introduction. The major and effective option for the treatment of liver echinococcosis are surgical operations. To choose a type of surgical intervention in a common form of liver echinococcosis under suspected deficit in the functional reserves of the organ and developing post-resection liver failure remains challenging.The aim of the study is to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The study included clinical findings of 24 patients with advanced liver echinococcosis (9/37.5% men, 15/62.5% women) who underwent surgical treatment in Surgical Department №2, Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky " (Kemerovo). The use of a two-stage major resection protocol was the criterion for inclusion in the study. Stage I was aimed to achieve vicarious hypertrophy of the contralateral lobe using various techniques to stop blood flow along the right branch of the portal vein. A two-stage protocol for extensive resection intervention was applied due to insufficient functional liver reserves and the small volume of the potential remnant; this resulted in the inability to safely use a single-stage extensive resection due to the predicted developing post-resection liver failure and a likely lethal outcome.Results and discussions. The applied surgical stage approaches for prevention of post-resection liver failure are effective due to the following parameters: CT volumetry (p0.05), residual concentration of indocyanine green at the 15th minute (p0.05), statistical model value (p0, 05). The level of effectiveness of the above technique is comparable with the laparotomic ligation of the right branch of the portal vein; however, the laparoscopic option is less traumatic, which can significantly reduce postoperative hospital stay (p0.05). In addition, there were no specific and nonspecific complications registered in case of the laparoscopic option.Conclusion. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when operations are performed in specialized hepatological centers using a comprehensive protocol for preoperative examination. They can be recommended in case of the initial significant deficit in the volume of the potential liver remnant and functional reserves of the organ.