Predictors of recurrence after surgery for hepatic hydatid cysts: Survival analysis and risk modeling from an endemic region.

OBJECTIVES

Hepatic cystic echinococcosis remains endemic in many regions, and surgery is the mainstay of treatment. However, postoperative recurrence remains a significant concern. This study aimed to identify predictors of recurrence after surgical management.

METHODS

We conducted a retrospective study including patients who underwent surgery for hepatic hydatid cysts between 2010 and 2022 in a tertiary center in Tunisia. Clinical, radiological, and operative variables were analyzed. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method and compared with the log-rank test. All variables were first assessed in univariate analysis; those with P < 0.10 were entered into a multivariable Cox regression model to identify independent predictors.

RESULTS

A total of 117 patients were included. After a mean follow-up of 32 ± 14 months (median 30 [IQR: 18-44]), recurrence occurred in nine patients (7.7%). In multivariable analysis, cyst calcification (HR: 3.6), gelatinous cyst content (HR: 4.1), and absence of omentoplasty (HR: 3.9) were independent predictors of recurrence. Albendazole therapy ≥3 months was associated with a reduced risk (HR: 0.28). The model showed good discrimination (AUC: 0.86).

CONCLUSION

Recurrence after hepatic hydatid cyst surgery is influenced by cyst characteristics and operative management. A structured risk-factor analysis identified independent predictors that may guide postoperative follow-up.