Echinococcosis in a non-endemic country – 20-years’ surgical experience from a Norwegian tertiary referral Centre

Figures & data

Table 1. Characteristics of patients with cystic echinococcosis (n = 90) and alveolar echinococcosis (n = 2), Oslo University Hospital, 2000–2020.

	Overall	Surgical treatment (n = 51)	Non-surgical treatment (n = 41)
Age, years (range)	37 (4–85)	34 (4–74)	39 (7–85)
Gender
Male	42	21	21
Female	50	30	20
Region of origin
Norway	2	1	1
Central and Eastern Europe	23^a	13	10
Northern Africa	7	2	5
Eastern Africa	7	6	1
Central Asia	4	2	2
Western Asia	34	17	17
Southern Asia	15	10	5
Symptoms and signs
Abdominal pain/discomfort	56	39	17
Chest pain	2	1	1
Dyspnoea	4	2	2
Other	6	5	1
Asymptomatic	24	4	20
Localization of cysts
Liver	67^a	35	32
Lung	6	2	4
Liver + lung	5	2	3
Liver + peritoneum	7	6	1
Peritoneum	3	3	0
Spleen	2	2	0
Small bowel	1	1	0
Urinary bladder	1	0	1
WHO classification of CE cysts of the liver
CE1	10	5	5
CE1 + CE2	1	1	0
CE1 + CE2 + CE3	1	0	1
CE1 + CE3A	1	0	1
CE2	16	12	4
CE3A	8	8	0
CE3B	18	16	2
CE4	13	7	6
CE4 + CE5	2	0	2
CE5	22	2	20

^aIncluding 2 patients resected for E. multilocularis.

Table 2. Reasons for abstaining from surgical treatment (PAIR, chemotherapy or watch and wait) (n = 41).

Reason	Number
Inactive cyst(s)	27
Technically inoperable	4
PAIR	6
Other	4
Age/comorbidity	1
Lost for follow-up (asylum seeker)	1
Patient preference	2

PAIR = puncture, aspiration, injection, and re-aspiration.

Table 3. Surgical procedures and complications in 50 patients undergoing surgical treatment for cystic echinococcosis at Oslo University Hospital.^a

Type of procedure	Number	Complications (Clavien Dindo)	Postoperative bile leak	Comments
Radical procedures n = 32
Liver
Total pericystectomy (cholecystectomy in two cases, omentoplasty in four cases)	10	–	–	–
Segment resection (resection of peritoneal cyst in two cases, cholecystectomy in one case)	8	2 (CD 3)	2	Bile leak in both patients
Wedge resection	2	1 (CD 3)	–	Liver abscess/pleural effusion/ pneumothorax
Right hemihepatectomy (resection of peritoneal cyst in one case, right adrenal gland/caval vein resection in one case)	3	2 (CD 3)	1	-Bile leak/intraabdominal abscess/pleural effusion -Pleural effusion
Other organs
Resection of peritoneal cyst (hemicolectomy in one case)	3	–	–	–
Splenectomy	2	–	–	–
Pulmonary resection	3	1 (CD 3)	–	–Bronchopleural fistula
Small bowel resection	1	–	–	–
Conservative procedures n = 12
Partial pericystectomy (liver) (cholecystectomy in four cases, omentoplasty in nine cases, resection of peritoneal cyst in one case)	12	4 (CD 3)	4	Bile leak in all four patients
Combined procedures n = 6
Segmentectomy (liver) + Partial pericystectomy (omentoplasty in one case)	3	3 (CD3 in two cases, CD 5 in one case)	–	-Bile duct injury -Liver abscess, pulmonary embolism -Myocardial infarction/death
Segmentectomy (liver) + Resection of multiple peritoneal cysts	1	1 (CD 4)	–	-Severe hypernatremia
Right hemihepatectomy + Partial pericystectomy + omentoplasty	1	1 (CD 4)	–	-Acute renal and respiratory failure, haemolytic uremic syndrome
Resection of peritoneal cyst + PAIR liver (performed during the same procedure)	1	–	–	–

^aOne additional patient underwent surgery at another Norwegian hospital and was excluded from analysis of surgical outcomes.

PAIR = puncture, aspiration, injection, and re-aspiration, CD = Clavien Dindo.