BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes o...BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.展开更多
Liver cirrhosis represents a major global health burden contributing to 1.5 million deaths annually(1,2).The most common causes of cirrhosis worldwide include chronic viral hepatitis B and C,alcohol-associated liver d...Liver cirrhosis represents a major global health burden contributing to 1.5 million deaths annually(1,2).The most common causes of cirrhosis worldwide include chronic viral hepatitis B and C,alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease(MASLD),with the latter showing a marked increase in prevalence in recent years(1,2).展开更多
Background and Aims:Hepatocellular carcinoma(HCC)surveillance in patients at risk is strongly recommended and usually performed by ultrasound(US)semiannually with or without alfa-fetoprotein(AFP)measurements.Quality p...Background and Aims:Hepatocellular carcinoma(HCC)surveillance in patients at risk is strongly recommended and usually performed by ultrasound(US)semiannually with or without alfa-fetoprotein(AFP)measurements.Quality pa-rameters except for surveillance intervals have not been strictly defined.We aimed to evaluate surveillance success and risk factors for surveillance failure.Methods:Patients with≥1 US prior to HCC diagnosis performed at four tertiary referral hospitals in Germany between 2008 and 2019 were retrospectively analyzed.Surveillance success was defined as HCC detection within Milan criteria.Results:Only 47%of 156 patients,median age 63(interquartile range:57-70)years,56%male,and 96%with cirrhosis,received recom-mended surveillance modality and interval.Surveillance fail-ure occurred in 29%and was significantly associated with lower median model for end-stage liver disease(MELD)score odds ratio(OR)1.154,95%confidence interval(CI):1.027-1.297,p=0.025)and HCC localization within right liver lobe(OR:6.083,95%CI:1.303-28.407,p=0.022),but not with AFP≥200μg/L.Patients with surveillance failure had sig-nificantly more intermediate/advanced tumor stages(93%vs.6%,p<0.001),fewer curative treatment options(15%vs.75%,p<0.001)and lower survival at 1 year(54%vs.75%,p=0.041),2 years(32%vs.57%,p=0.019)and 5 years(0%vs.16%,p=0.009).Alcoholic and non-alcoholic fatty liver disease(OR:6.1,95%CI:1.7-21.3,p=0.005)and ascites(OR:3.9,95%CI:1.2-12.6,p=0.021)were in-dependently associated with severe visual limitations on US.Conclusions:US-based HCC surveillance in patients at risk frequently fails and its failure is associated with unfavorable patient-related outcomes.Lower MELD score and HCC lo-calization within right liver lobe were significantly associated with surveillance failure.展开更多
文摘BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.
文摘Liver cirrhosis represents a major global health burden contributing to 1.5 million deaths annually(1,2).The most common causes of cirrhosis worldwide include chronic viral hepatitis B and C,alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease(MASLD),with the latter showing a marked increase in prevalence in recent years(1,2).
文摘Background and Aims:Hepatocellular carcinoma(HCC)surveillance in patients at risk is strongly recommended and usually performed by ultrasound(US)semiannually with or without alfa-fetoprotein(AFP)measurements.Quality pa-rameters except for surveillance intervals have not been strictly defined.We aimed to evaluate surveillance success and risk factors for surveillance failure.Methods:Patients with≥1 US prior to HCC diagnosis performed at four tertiary referral hospitals in Germany between 2008 and 2019 were retrospectively analyzed.Surveillance success was defined as HCC detection within Milan criteria.Results:Only 47%of 156 patients,median age 63(interquartile range:57-70)years,56%male,and 96%with cirrhosis,received recom-mended surveillance modality and interval.Surveillance fail-ure occurred in 29%and was significantly associated with lower median model for end-stage liver disease(MELD)score odds ratio(OR)1.154,95%confidence interval(CI):1.027-1.297,p=0.025)and HCC localization within right liver lobe(OR:6.083,95%CI:1.303-28.407,p=0.022),but not with AFP≥200μg/L.Patients with surveillance failure had sig-nificantly more intermediate/advanced tumor stages(93%vs.6%,p<0.001),fewer curative treatment options(15%vs.75%,p<0.001)and lower survival at 1 year(54%vs.75%,p=0.041),2 years(32%vs.57%,p=0.019)and 5 years(0%vs.16%,p=0.009).Alcoholic and non-alcoholic fatty liver disease(OR:6.1,95%CI:1.7-21.3,p=0.005)and ascites(OR:3.9,95%CI:1.2-12.6,p=0.021)were in-dependently associated with severe visual limitations on US.Conclusions:US-based HCC surveillance in patients at risk frequently fails and its failure is associated with unfavorable patient-related outcomes.Lower MELD score and HCC lo-calization within right liver lobe were significantly associated with surveillance failure.
