Options for Two-Stage Extensive Liver Resections in the Surgical Treatment of Advanced Liver Echinococcosis

Introduction. The major and effective option for the treatment of liver echinococcosis are surgical operations. To choose a type of surgical intervention in a common form of liver echinococcosis under suspected deficit in the functional reserves of the organ and developing post-resection liver failure remains challenging.
The aim of the study is to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.
Materials and methods. The study included clinical findings of 24 patients with advanced liver echinococcosis (9/37.5% men, 15/62.5% women) who underwent surgical treatment in Surgical Department №2, “Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky " (Kemerovo). The use of a two-stage major resection protocol was the criterion for inclusion in the study. Stage I was aimed to achieve vicarious hypertrophy of the contralateral lobe using various techniques to stop blood flow along the right branch of the portal vein. A two-stage protocol for extensive resection intervention was applied due to insufficient functional liver reserves and the small volume of the potential remnant; this resulted in the inability to safely use a single-stage extensive resection due to the predicted developing post-resection liver failure and a likely lethal outcome.
Results and discussions. The applied surgical stage approaches for prevention of post-resection liver failure are effective due to the following parameters: CT volumetry (p<0.05), residual concentration of indocyanine green at the 15th minute (p<0.05), statistical model value (p<0, 05). The level of effectiveness of the above technique is comparable with the laparotomic ligation of the right branch of the portal vein; however, the laparoscopic option is less traumatic, which can significantly reduce postoperative hospital stay (p<0.05). In addition, there were no specific and nonspecific complications registered in case of the laparoscopic option.
Conclusion. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when operations are performed in specialized hepatological centers using a comprehensive protocol for preoperative examination. They can be recommended in case of the initial significant deficit in the volume of the potential liver remnant and functional reserves of the organ.