Surgical management of hepatic cystic echinococcosis – a 20-year case series and outcome analysis

Background

Cystic echinococcosis (CE) is a parasitic zoonosis, caused by the larval stage of Echinococcus granulosus , typically forming cysts in the liver. If left untreated, CE can be life-threatening. Albendazole remains the standard medical therapy, but surgical intervention is indicated in selected cases.

Methodology/Principal Findings

We conducted a retrospective, multicenter outcome analysis in Switzerland of surgically treated hepatic cystic echinococcosis from 2004 to 2024. Thirty-one patients with CE stages I-III who underwent pericystectomy, endocystectomy, or minimally invasive procedures were included. The primary objective was to evaluate the safety and efficacy of surgical treatment. Data on patient demographics, disease characteristics, and perioperative morbidity and mortality, as well as recurrence rates stratified by surgical technique were analyzed.

All patients received adjuvant albendazole therapy for a median duration of 4 months (3–204 months). Across 32 surgical interventions, most patients (81.3%; n=26) had one or two cysts (1– 8), with a median cyst size of 8 cm (3–19 cm). The median follow-up was 78 months (12–230 months). The overall recurrence rate was 6.3% (n=2); however, there were no recurrences observed after pericystectomy (n= 0) or endocystectomy (n=0). The 90-day postoperative mortality rate was 0%.

Conclusions

In combination with established pharmacological therapy, surgery remains a safe and effective treatment option for CE, associated with low recurrence and negligible perioperative mortality. Surgical therapy should be considered a valuable component of CE management, especially in patients who are not optimal candidates for antihelmintic therapy alone.

Author Summary

Cystic echinococcosis is a parasitic disease that causes cystic lesions, most commonly in the liver. Although antiparasitic medication plays an important role, surgery remains the only curative option in selected cases. A key surgical question concerns the extent of resection— whether to remove only the cyst contents and inner layers or to perform a complete excision of the cyst, including its pericystic wall. This decision has important implications for radicality, preservation of healthy tissue, and the risk of recurrence.

We conducted a multicenter, retrospective analysis covering 20 years of surgical treatment for cystic echinococcosis at a Swiss tertiary referral center and partner hospitals. Among 31 patients undergoing 32 procedures, pericystectomy was the most common technique. This method achieved complete removal of the cyst and was associated with no recurrences during long-term follow-up, whereas more conservative approaches showed isolated relapses. Overall morbidity was low, and there was no procedure-related mortality.

These findings support pericystectomy, combined with perioperative anthelmintic therapy, as an effective and safe standard of care for selected patients requiring operative treatment.