Surgical management of cystic echinococcosis-A 20-year case series and outcome analysis.

BACKGROUND

Cystic echinococcosis (CE) is a parasitic zoonosis, caused by the larval stage of Echinococcus granulosus, typically forming cysts in the liver. If untreated, CE can be life-threatening. Albendazole remains the standard medical therapy, but surgical intervention is indicated in selected cases.

METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective, multicenter outcome analysis in Switzerland of surgically treated cystic echinococcosis from 2004 to 2024. Patients with CE stages 1-3b undergoing pericystectomy, endocystectomy, or non-resectional procedures were included. The primary objective was to evaluate the safety and efficacy of surgical treatment. Data on patient demographics, disease characteristics, and perioperative morbidity and mortality, as well as recurrence rates stratified by surgical technique were analyzed. Among 37 patients, 83.8% (n = 31) had hepatic involvement, 8.1% (n = 3) pulmonary, 5.4% (n = 2) intestinal, and 2.7% (n = 1) psoas involvement. All patients received adjuvant albendazole therapy for a median duration of 4 months (3-204 months). Across 39 surgical interventions, 82.1% of procedures (n = 32) had one or two cysts (range 1-8), with a median cyst size of 8 cm (2.1-19 cm). The median follow-up was 93 months (12-230 months). The overall recurrence rate at the procedure level was 7.7% (n = 3), occurring after three different procedures (endocystectomy, cyst aspiration and fenestration, and open PAIR with cyst deroofing). No recurrences were observed after pericystectomy (0/32 procedures). The 90-day postoperative mortality rate was 0%.

CONCLUSIONS

In this cohort, surgical treatment, particularly pericystectomy, was associated with low recurrence and no 90-day mortality. These findings support surgery as an important component of multimodal management in appropriately selected patients.