Preliminary Clinical Study In The Feasibility, Safety And Efficacy Of Simultaneous Combined Surgery For Hepatic And Renal Alveolar Echinococcosis

Objectives:To evaluate the feasibility,safety and efficacy of radical simultaneous combined surgery(R-SCS)for hepatic and renal alveolar echinococcosis(AE).Methods:Altogether 10 hepatic and renal AE cases hospitalized in the First Affiliated Hospital of Xinjiang Medical University were retrospectively collected.General condition,past medical history,clinical manifestations,lesion features,surgical approach,peri-operative recovery,long-term follow-up data and disease prognosis were analyzed.There were 8 males and 2 females,with a median age of 48 years(range 27 to 52 years).Seven patients(70.0%,7/10)had previously undergone palliative resection of liver AE or liquefaction of the lesion by liquefaction,and all patients had recurrence of liver AE with renal invasion;2 patients with no history of AE had new AE lesion Liver and right kidney invasion at the same time,1 case was previously diagnosed but not treated.The clinical symptoms of 7 patients(70%,7/10)were mainly abdominal pain,low back pain,fatigue,melena,upper gastrointestinal bleeding,nausea and vomiting,and the other 3 patients had no obvious symptoms.All patients(100%,10/10)involved lesions of the right lobe and the right kidney of the liver,including one with the left outer lobe of the liver and one with the left kidney.In terms of lesion morphology and biological activity,intermediate liquefied lesions accounted for 70%(7/10),of which 6 had peripheral biological activity;vesicular lesions and scattered calcified lesions accounted for 20%(2/10)and 10%(1/10)Results:All patients were successfully managed by R-SCS.Of nine lesions in the liver,nine were radically resected by hepatectomy,two earned sageresection by ex vivo liver resetion and autotransplantation(ELRA);and respectively seven and four renal lesions were radically eradicated by total and partial nephrectomy.None of the cases experienced postoperative complications equal or higher than Clavien IIIb.Morbidity of Clavien IIIa complication rate was 40%(4/10): one early urinary leakage(managed by ureteral tube placement),three hydrothoraxes(cured by thoracentesis and drainage).Patients had transient and minor liver and renal functions disorder which was a common response to general surgeries,however none of them encountered organ failures.During median 18 months(3-78 months)regular follow-up,one incisional hernia occurred and managed laparoscopically.All living without AE,no death or disease relapse were observed achieving 100% clinical cure.Conclusions:When complied strictly to indications,R-SCS could be a feasible,safe and efficient approach for patients with hepatic and renal double organ AE,which was primary or relapsed from previous hepatic AE surgery or interventional therapies.