Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis

Abstract

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.

Keywords

liver hydatid cysts / radical surgery / conservative surgery / meta-analysis / complications

References

[1] Gomez I Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz Á, Orbis Castellanos F, Pareja Ibars E, San Juan Rodríguez F. Review of the treatment of liver hydatid cysts. World J Gastroenterol 2015; 21(1): 124–131

[2] Georgiou GK, Lianos GD, Lazaros A, Harissis HV, Mangano A, Dionigi G, Katsios C. Surgical management of hydatid liver disease. Int J Surg 2015;20:118–122

[3] Yagci G, Ustunsoz B, Kaymakcioglu N, Bozlar U, Gorgulu S, Simsek A, Akdeniz A, Cetiner S, Tufan T. Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients. World J Surg 2005; 29(12): 1670–1679

[4] Sayek I, Tirnaksiz MB, Dogan R. Cystic hydatid disease: current trends in diagnosis and management. Surg Today 2004; 34(12): 987–996

[5] Milićević M. Commentary. Radical versus conservative surgical treatment of liver hydatid cysts (Br J Surg 2014; 101: 669-675). Br J Surg 2014; 101(6): 676

[6] Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE.Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114(1): 1–16

[7] Birnbaum DJ, Hardwigsen J, Barbier L, Bouchiba N, Le Treut YP. Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg 2012; 16(11): 2086–2093

[8] Dziri C, Haouet K, Fingerhut A. Treatment of hydatid cyst of the liver: where is the evidence? World J Surg 2004; 28(8): 731–736

[9] Akbulut S, Senol A, Sezgin A, Cakabay B, Dursun M, Satici O. Radical vs. conservative surgery for hydatid liver cysts: experience from single center. World J Gastroenterol 2010; 16(8): 953–959

[10] Daradkeh S, El-Muhtaseb H, Farah G, Sroujieh AS, Abu-Khalaf M. Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver. Langenbecks Arch Surg 2007; 392(1): 35–39

[11] Sielaff TD, Taylor B, Langer B. Recurrence of hydatid disease. World J Surg 2001; 25(1): 83–86

[12] Jerraya H, Khalfallah M, Osman SB, Nouira R, Dziri C. Predictive factors of recurrence after surgical treatment for liver hydatid cyst. Surg Endosc 2015; 29(1): 86–93

[13] Secchi MA, Pettinari R, Mercapide C, Bracco R, Castilla C, Cassone E, Sisco P, Andriani O, Rossi L, Grondona J, Quadrelli L, Cabral R, Rodríguez León N, Ledesma C. Surgical management of liver hydatidosis: a multicentre series of 1412 patients. Liver Int 2010; 30(1): 85–93

[14] El Malki HO, Souadka A, Benkabbou A, Mohsine R, Ifrine L, Abouqal R, Belkouchi A. Radical versus conservative surgical treatment of liver hydatid cysts. Br J Surg 2014; 101(6): 669–675

[15] Zheng Z, Zhou L, Gao S, Yang Z, Yao J, Zheng S. Prognostic role of C-reactive protein in hepatocellular carcinoma: a systematic review and meta-analysis. Int J Med Sci 2013; 10(6): 653–664

[16] Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB; Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group.Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000; 283(15): 2008–2012

[17] Yüksel O, Akyürek N, Sahin T, Salman B, Azili C, Bostanci H. Efficacy of radical surgery in preventing early local recurrence and cavity-related complications in hydatic liver disease. J Gastrointest Surg 2008; 12(3): 483–489

[18] Magistrelli P, Masetti R, Coppola R, Messia A, Nuzzo G, Picciocchi A. Surgical treatment of hydatid disease of the liver. A 20-year experience. Arch Surg 1991; 126(4): 518–522, discussion 523

[19] Gollackner B, Längle F, Auer H, Maier A, Mittlböck M, Agstner I, Karner J, Langer F, Aspöck H, Loidolt H, Rockenschaub S, Steininger R. Radical surgical therapy of abdominal cystic hydatid disease: factors of recurrence. World J Surg 2000; 24(6): 717–721

[20] Cirenei A, Bertoldi I. Evolution of surgery for liver hydatidosis from 1950 to today: analysis of a personal experience. World J Surg 2001; 25(1): 87–92

[21] Yorganci K, Sayek I. Surgical treatment of hydatid cysts of the liver in the era of percutaneous treatment. Am J Surg 2002; 184(1): 63–69

[22] Chautems R, Buhler L, Gold B, Chilcott M, Morel P, Mentha G. Long term results after complete or incomplete surgical resection of liver hydatid disease. Swiss Med Wkly 2003; 133(17-18): 258–262

[23] De Werra C, Condurro S, Tramontano S, Perone M, Donzelli I, Di Lauro S, Di Giuseppe M, Di Micco R, Pascariello A, Pastore A, Diamantis G, Galloro G. Hydatid disease of the liver: thirty years of surgical experience. Chir Ital 2007; 59(5): 611–625

[24] Aydin U, Yazici P, Onen Z, Ozsoy M, Zeytunlu M, Kiliç M, Coker A. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence. Turk J Gastroenterol 2008; 19(1): 33–39

[25] Priego P, Nuño J, López Hervás P, López Buenadicha A, Peromingo R, Díe J, Rodríguez G. Hepatic hydatidosis. Radical vs. conservative surgery: 22 years of experience. Rev Esp Enferm Dig 2008; 100(2): 82–85 (in Spanish)

[26] Motie MR, Ghaemi M, Aliakbarian M, Saremi E. Study of the radical vs. conservative surgical treatment of the hepatic hydatid cyst: a 10-year experience. Indian J Surg 2010; 72(6): 448–452

[27] Gupta N, Javed A, Puri S, Jain S, Singh S, Agarwal AK. Hepatic hydatid: PAIR, drain or resect? J Gastrointest Surg 2011; 15(10): 1829–1836

[28] Tagliacozzo S, Miccini M, Amore Bonapasta S, Gregori M, Tocchi A. Surgical treatment of hydatid disease of the liver: 25 years of experience. Am J Surg 2011; 201(6): 797–804

[29] Salamone G, Tutino R, Atzeni J, Licari L, Falco N, Orlando G, Gulotta G. Liver hydatidosis: reasoned indications of surgical treatment. Comparison between conservative and radical techniques Retrospective study. Ann Ital Chir 2014; 85(5): 422–430

[30] He YB, Yao G, Tuxun T, Bai L, Li T, Zhao JM, Zhang JH, Wen H. Efficacy of radical and conservative surgery for hepatic cystic echinococcosis: a meta-analysis. Int J Clin Exp Med 2015; 8(5): 7039–7048

[31] Manterola C, Otzen T, Urrutia S; MINCIR Group (Methodology and Research in Surgery). Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst. Int J Surg 2014; 12(7): 695–699

[32] Bedioui H, Bouslama K, Maghrebi H, Farah J, Ayari H, Hsairi H, Kacem M, Jouini M, Bensafta Z. Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst. Pan Afr Med J 2012;13:29

[33] Baraket O, Moussa M, Ayed K, Kort B, Bouchoucha S. Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver. Arab J Gastroenterol 2014; 15(3-4): 119–122

[34] Zeybek N, Dede H, Balci D, Coskun AK, Ozerhan IH, Peker S, Peker Y. Biliary fistula after treatment for hydatid disease of the liver: when to intervene. World J Gastroenterol 2013; 19(3): 355–361

[35] El Malki HO, El Mejdoubi Y, Souadka A, Mohsine R, Ifrine L, Abouqal R, Belkouchi A. Predictive factors of deep abdominal complications after operation for hydatid cyst of the liver: 15 years of experience with 672 patients. J Am Coll Surg 2008; 206(4): 629–637

[36] Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK. Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol 2005; 24(2): 55–58

[37] Joliat GR, Melloul E, Petermann D, Demartines N, Gillet M, Uldry E, Halkic N. Outcomes after liver resection for hepatic alveolar echinococcosis: a single-center cohort study. World J Surg 2015; 39(10): 2529–2534

[38] Yağmur Y, Akbulut S, Gümüş S, Babür M, Can MA. Laparoscopic management of hydatid cyst of the liver. S Afr J Surg 2016; 54(3): 14–17

[39] Jabbari Nooghabi A, Mehrabi Bahar M, Asadi M, Jabbari Nooghabi M, Jangjoo A. Evaluation and comparison of the early outcomes of open and laparoscopic surgery of liver hydatid cyst. Surg Laparosc Endosc Percutan Tech 2015; 25(5): 403–407

[40] Zaharie F, Bartos D, Mocan L, Zaharie R, Iancu C, Tomus C. Open or laparoscopic treatment for hydatid disease of the liver? A 10-year single-institution experience. Surg Endosc 2013; 27(6): 2110–2116

Acknowledgements

This research was supported by the National Natural Science Foundation of China (No. 81600452) and the Science and Technology Innovation Fund Project of Anhui Province (No. 1501041155).

Compliance with ethics guidelines

Qing Pang, Hao Jin, Zhongran Man, Yong Wang, Song Yang, Zongkuang Li, Yimin Lu, Huichun Liu, Lei Zhou and declare that they have no conflict of interest. The experiments comply with the current laws of the country in which they were performed.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at http://dx.doi.org/ 10.1007/s11684-017-0559-y and is accessible for authorized users.

RIGHTS & PERMISSIONS

2017 Higher Education Press and Springer-Verlag GmbH Germany