The Long-term Follow-up And Evaluation Of Subadventitial Total Exocystectomy For Hepatic Hydatid Disease

Objective The aim of this study is to find out possible predictors for this high morbidity and recurrence for the post-operative patients with liver hydatid disease through a retrospective study, and evaluate the efficacy of surgical procedures in hepatic hydatid disease by long-term follow-up , and provide reference for clinical therapy.Methods The 244 cases(130 men, 114 women), who underwent surgeries from October 1999 to December 2007 in our hospital, for hydatid cyst of the liver, were retrospectively reviewed, the age range was from 5 to 70 years (mean=36.7 years), The mortality and the recurrence rates were assessed as well as the following eight potential predictors of mortality and recurrence: age of the patients, size of the cyst, the presence of preoperative complications, the type of surgery performed(new radical or conservative), whether the disease was new or recurrent, open or close of the pericyst, other organs involved by the disease, number of cysts, Cross-tabulation and logistic regression between mortality and recurrence rate (dependent variable) and the above mentioned eight potential predictors (independent variables) were carried out. Two groups of surgical procedures were performed (new radical or conservative) and the clinical data (mobidity, motality, relapse rate, survival rate, quality of life) were analyzed relatively. Among the 244 patients, 196(80.3%) were available for long-term follow-up, the median follow-up period was 39 months (range:3-96 months). Cross-tabulation and logistic regression between mortality and recurrence (dependent variable) and the above-mentioned eight potential predictors (independent variables) were carried out.Results Morbidity rates were 54.0% (27/50) following conservative surgery and 2.1 % (4/194) following new radical surgery (Subadventitial Total Exocystectomy), The differences of morbidity between the two procedures were statistically significant; Patients of age >40 years, with a cyst diameter of >10cm, who presented with pre-operative complications, who had conservative surgery, the disease was recurrent, open of pericyst and multiple of cysts were having a significantly higher morbidity rate. The rate of recurrence were significantly lower after Subadventitial Total Exocystectomy (0.63% (1/160)] than following conservative surgery (22.2% (8/36)], The differences of the rate of recurrence between two procedures were also statistically significant, and the patients of age>40 years, with a cyst diameter of >10 cm, who presented with pre-operative complications, who had conservative surgery, the disease was recurrent, open of pericyst were having a significantly higher morbidity rate; The recurrence after closed Subadventitial Total Exocystectomy of the cyst was zero. Multiple regression analysis showed that: the age of patients was a risk factor for recurrence and morbidity, removel pericyst (the type of surgery )was a protective factor for recurrence and morbidity. The disease-free survival and quality of life in "close Subadventitial total exocystectomy were higher than that in pericystectomy (p=<0.05; P <0.01).Conclusion 1) Age of the patients, size of the cyst, the presence of preoperative complications, the type of surgery performed (new radical or conservative), whether the disease was new or recurrent, open or close of pericyst, number of cysts represent as significant predictors of morbidity(30 days) of surgery for liver hydatid cyst. And the presence of preoperative complications, the type of surgery performed (new radical or conservative), whether the disease was new or recurrent, open or close of pericyst caused higher rate of recurrence after operations.2) Residual radicular cyst cavity of pericyst was reasonable explanation for complications above mentioned. The results indicate that Subadventitial total exocystectomy can decrease the complications of liver residual cavity and recurrence rate "close Subadventitial total exocystectomy" and should be selected firstly because of the most satisfactory effectiveness.3) Removing exocyst is the best way to decrease the rate of recurrence and complications of residual cavity, which mainly result from left exocysts during operation.