In:
British Journal of Surgery, Oxford University Press (OUP), Vol. 92, No. 9 ( 2005-08-17), p. 1110-1116
Abstract:
Alveolar echinococcosis is a rare disorder, which makes a comparison of different treatment modalities within a clinical trial difficult to perform. Data prospectively recorded over a period of 25 years were used to evaluate three therapeutic strategies: benzimidazole therapy alone, complete ‘curative’ resection followed by 2 years of adjuvant benzimidazole treatment, and partial debulking resection followed by continuous administration of a benzimidazole. Methods Details of 113 patients with hepatic alveolar echinococcosis treated between 1976 and 2003 were analysed. Kaplan–Meier survival curves were constructed and, using a Cox regression model, patient age, year of initial treatment and PNM stage were entered as co-variates in the analysis. Results Kaplan–Meier overall survival curves stratified for treatment strategy indicated an improved long-term survival in patients undergoing the debulking procedure (P = 0·061) or curative resection (P = 0·002) compared with benzimidazole therapy alone. However, when PNM stage, patient age and year of initial treatment were introduced into the analysis, there was a trend for survival advantage only with curative resection (P = 0·07 versus benzimidazole alone). Debulking resulted in a higher rate of progression of hepatic echinococcosis than curative surgery (P = 0·008). The incidence of parasite-related complications was similar for debulking resection and benzimidazole therapy alone (P = 0·706). Conclusion Debulking hepatic resections do not appear to offer any advantage in the treatment of patients with alveolar echinococcosis.
Type of Medium:
Online Resource
ISSN:
0007-1323
,
1365-2168
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2005
detail.hit.zdb_id:
2006309-X
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