Recent advances in surgical strategies for alveolar echinococcosis of the liver


Liver resection is the safest intervention for alveolar echinococcosis (AE), because the only potentially curative treatment is complete removal of the lesion. In combination with medical anthelmintic treatment, a safe distance of at least 1 mm is permissible in this procedure. Even when liver resection does not cure AE, good long-term survival outcomes can be achieved if most of the lesion has been removed and the disease is controlled with lifelong benzimidazole treatment. If the residual lesion is comparatively small and does not contain a closed space that may adhere to the surrounding tissue and form an abscess, complications such as sepsis arising from an abscess on the cut surface can be prevented and the required biliary drainage might be relatively simple. Larger AE lesions that invade the inferior vena cava can be treated effectively with the recent advances in reduction surgical techniques. An effective concentration of albendazole (ABZ) is found only in the periphery of AE lesions, because this drug penetrates the lesions passively. Liver transplantation, with adjuvant ABZ and the administration of appropriate immunosuppressive agents such as cyclosporin A, is indicated for patients with end-stage AE.

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Alveolar echinococcosis


World Health Organization


Informal Working Group on Echinococcosis




Inferior vena cava




Liver transplantation


Living-donor liver transplantation


Immunosuppressive status


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I thank Ms. Ayumi Kondo for her assistance with this article.

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The author was responsible for the conception and design of the study; literature review and analysis; drafting, critical revision, and editing; and approval of the final version.

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Correspondence to Toshiya Kamiyama.

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Kamiyama, T. Recent advances in surgical strategies for alveolar echinococcosis of the liver. Surg Today 50, 1360–1367 (2020).

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  • Alveolar echinococcosis
  • Liver
  • Hepatectomy