Surgical management of pulmonary hydatid cysts: is size an important prognostic indicator?

Giant hydatid cysts of the lung (diameter, ≥10 cm) are considered more difficult to treat surgically than are smaller cysts. We reviewed our experience with giant pulmonary hydatid cysts, focusing on clinical symptoms, cystic location, extent of surgery, and postoperative complications, according to age, long-term results, and comparison with non-giant cysts. From January 1988 to January 2008, 537 patients underwent surgery for pulmonary hydatid cysts. We separated patients into 2 groups: patients who had cysts <10 cm (group A) and those who had giant cysts (group B). Group B comprised 75 patients (14%). Giant cysts were more common in younger patients (mean age, 30 vs 32 yr; P=0.014). The most frequent complaints were cough, chest pain, and dyspnea. Patients with giant cysts were more often symptomatic at presentation (96% vs 88%; P=0.04). In both groups, lower-lobe locations predominated. Parenchyma-saving operations were almost uniformly performed for each group; however, a higher percentage of patients in group B required anatomic resection (4% vs 1%; P=0.038). Fifty-seven patients (10%) also underwent resection of concomitant liver cysts. Cystic rupture occurred more frequently in group B than in group A (27% vs 15%; P=0.01). There were no deaths in either group, nor were there significant differences in morbidity between groups.In summary, giant hydatid cysts of the lung occurred more often in younger patients and were more often symptomatic at presentation. Regardless of size, the cysts could usually be surgically treated without lung resection, and size did not appear to influence short-term perioperative outcomes.