Radical versus conservative surgical treatment of liver hydatid cysts

• Published in: British journal of surgery Vol. 101; no. 6; pp. 669 - 675
• Main Authors: El Malki, H. O., Souadka, A., Benkabbou, A., Mohsine, R., Ifrine, L., Abouqal, R., Belkouchi, A.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.05.2014; Oxford University Press
• Subjects: Adult; Aged; Echinococcosis, Hepatic - prevention & control; Echinococcosis, Hepatic - surgery; Female; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Postoperative Complications - etiology; Propensity Score; Reoperation - statistics & numerical data; Retrospective Studies; Secondary Prevention; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9408

Background The management of liver hydatid cysts is controversial. Surgery remains the basic treatment, and can be divided into radical and conservative approaches. The purpose of this study was to compare the results of radical and conservative surgery in the treatment of liver hydatid cysts. Methods Data from all patients with liver hydatid cyst treated in a hepatobiliary surgical unit, between January 1990 and December 2010, were retrieved from a retrospective database. To minimize selection bias, propensity score matching was performed, based on 17 variables representing patient characteristics and operative risk factors. The primary outcome measure was hydatid cyst recurrence. Results One hundred and seventy patients were matched successfully, representing 85 pairs who had either a radical or a conservative approach to surgery. At a median (i.q.r.) follow‐up of 106 (59–135) and 87 (45–126) months in the radical and conservative groups respectively, the recurrence rate was 4 per cent in both groups (odds ratio (OR) 1·00, 95 per cent confidence interval 0·19 to 5·10). There were no statistically significant differences between conservative and radical surgery in terms of operative mortality (1 versus 0 per cent; P = 0·497), deep abdominal complications (12 versus 16 per cent; OR 1·46, 0·46 to 3·49), overall postoperative complications (15 versus 19 per cent; OR 1·28, 0·57 to 2·86), reinterventions (0 versus 4 per cent; P = 0·246) and median hospital stay (7 (i.q.r. 5–12) days in both groups; P = 0·220). Conclusion This study could not demonstrate that radical surgery reduces recurrence and no trend towards such a reduction was observed. Radical surgery is not better