Simultaneous combined surgery for hepatic-renal double organ alveolar or cystic echinococcosis: A retrospective study

Table 1 Simultaneous combined surgery for hepatorenal involvement of alveolar echinococcosis and patient outcomes

Patient	Surgery					Blood loss (mL)	Blood transfusion (U/mL)2	LOS (day)	Complication	Medication (month)	Follow-up (month)	Prognosis
	Hepatic	Renal	Other1	Duration (hour)	Summary
P1	ELRA, choledocal drainage	Right PN	Right ADX, diaphragm and IVC repair; PV repair; pulmonary wedge rection, thorax drainage; cholecystectomy	20.0	Radical	3500	8/526	21	No	24	81	Cured
P2	Right hemihepatectomy (stage II)	Right TN (stage II), left PN (stage I)	Right ADX, diaphragm and IVC repair; duodenum and abdominal wall repair	4.0	Radical	680	3/680	19	Hydrothorax (IIIa)	24	42	Cured
P3	Right trisectionectomy	Right TN	Right ADX, diaphragm repair with artificial patch, IVC replacement with vascular prosthesis, PV repair; pulmonary wedge resection, thorax drainage	8.5	Radical	1200	5/910	13	No	23	23	Cured
P4	Right trisectionectomy, caudate lobectomy	Right TN	Right ADX, diaphragm repair with artificial patch, IVC replacement with vascular prosthesis; PV repair; thorax drainage; cholecystectomy	7.5	Radical	1200	3/610	23	No	22	22	Cured
P5	Right hemihepatectomy	Right PN	Right ADX, diaphragm repair with artificial patch, thorax drainage, abdominal lesion resection and repair, cholecystectomy	5.5	Radical	300	0/0	12	Incisional hernia (IIIb)	22	22	Cured
P6	Right hemihepatectomy, partial hepatectomy	Right TN	Right ADX, IVC repair, cholecystectomy	5.0	Radical	400	2/600	8	No	20	20	Cured
P7	Right hemihepatectomy	Right TN	Diaphragm repair, thorax drainage, cholecystectomy	5.3	Radical	800	2/470	5	No	18	18	Cured
P8	Right hemihepatectomy	Right TN	Right ADX, diaphragm repair; IVC replacement with vascular prosthesis; cholecystectomy	7.0	Radical	1000	3/800	13	Hydrothorax (IIIa)	14	14	Cured
P9	ELRA	Right TN	PV repair; cholecystectomy	17.0	Radical	3000	14/740	23	Hydrothorax (IIIa)	6	6	Cured
P10	Right hemihepatectomy, caudate lobectomy	Right PN	No	4.5	Radical	250	0/0	13	Urinary leakage (IIIb)	6	6	Cured

¹Surgeries for other organs/structures.

²Red blood cell/plasma.

PV: Portal vein; ELRA: Ex vivo liver resection and autotransplantation; PN: Partial nephrectomy; TN: Total nephrectomy; ADX: Adrenalectomy; IVC: Inferior vena cava; LOS: Length of stay in hospital.

Table 2 Simultaneous combined surgery for hepatorenal involvement of cystic echinococcosis and patient outcomes

Patient	Surgery					Blood loss (mL)	LOS (day)	Complication	Medication (month)	Follow-up (month)	Prognosis
	Hepatic	Renal	Other1	Duration (hour)	Summary
P11	Subtotal cystectomy plus endocystectomy (OC)	Partial cystectomy plus endocystectomy (OC)	No	2.3	Non-radical	100	9	No	12	123	Cured
P12	Total cystectomy (NOC)	Total cystectomy (NOC)	Total cystectomy (NOC)	2.5	Radical	50	8	No	6	106	Cured
P13	Total cystectomy (NOC)	Right PN (NOC)	Total cystectomy (NOC); IVC repair	2.7	Radical	100	8	No	6	55	Cured
P14	Right hemihepatectomy (NOC)	Left TN (NOC)	Total cystectomy (NOC); IVC repair, cholecystectomy	3.3	Radical	200	7	Pneumonia (II)	6	51	Cured
P15	Subtotal cystectomy plus endocystectomy (OC)	Partial cystectomy plus endocystectomy (OC)	No	3.0	Non-radical	100	7	No	12	49	Cured
P16	Total cystectomy (NOC)	Total cystectomy (NOC)	Right ADX, diaphragm repair, cholecystectomy	1.8	Radical	50	6	Pneumonia (II)	6	42	Cured
P17	Total cystectomy (NOC)	Left TN (NOC)	No	1.6	Radical	200	5	No	6	40	Cured
P18	RL: Total cystectomy (NOC); LLL: Total cystectomy (NOC)	Total cystectomy (NOC)	Total cystectomy (NOC)	2.2	Radical	100	6	No	3	37	Cured
P19	Partial cystectomy plus endocystectomy (OC)	Partial cystectomy plus endocystectomy (OC)	No	3.0	Non-radical	100	10	No	6	37	Cured
P20	Total cystectomy (NOC)	Total cystectomy (NOC)	No	1.4	Radical	100	6	No	6	35	Cured
P21	RL: Subtotal cystectomy plus endocystectomy (OC); LLL: Subtotal cystectomy plus endocystectomy (OC); choledocal drainage	Right TN (NOC)	Subtotal cystectomy (OC); cholecystectomy	4.5	Non-radical	200	9	No	24	34	Cured

¹Surgeries for other organs/structures.

No blood transfusion in all patients. PN: Partial nephrectomy; TN: Total nephrectomy; ADX: Adrenalectomy; IVC: Inferior vena cava; LOS: Length of stay in hospital; NOC: Non-opened cyst; OC: Opened cyst; RL: Right lobe; LLL: Left lobe of liver.

Table 3 A comparison of surgical approach and outcomes between the alveolar echinococcosis and cystic echinococcosis cohorts

Items	AE cohort	CE cohort
Hepatic surgery (n)
Hemihepatectomy	6 (right)	1 (right)
Trisectionectomy	2 (right)	0
ELRA	2	0
Lobectomy	1	0
Partial hepatectomy	1	0
NOC surgery	0	8
OC surgery	0	5
Renal surgery (n)
PN	4 (3 right, 1 left)	1 (right)
TN	7 (right)	3 (1 right, 2 left)
NOC surgery	0	8
OC surgery	0	3
Surgery for extra lesions/cysts (n)
NOC surgery	0	6 (2 abdominal, 1 pelvic, 3 retroperitoneal)
OC surgery	0	1 (retroperitoneal)
Adrenalectomy	7 (right)	1 (right)
Diaphragmatic repair	4 (right)	1 (right)
Diaphragmatic reconstruction	3 (right)	0
IVC repair	3	2
IVC reconstruction	3 (1 retrohepatic IVC, 2 retrohepatic plus below-renal-venous level IVC)	0
PV repair	4	0
Pulmonary wedge resection	2 (right)	0
Thorax drainage	4 (right)	0
Choledocal drainage	1	1
Cholecystectomy	7	3
Surgical summary
Radicality (%)	100 (10/10)	63.6 (7/11)
Median duration (hour)	6.3	2.5
Estimated blood loss (mL)	900	100
Post-OP hospital stay (day)	13	7
Prognosis (%)
Complication rate	50 (5/10: 3 IIIa, 2 IIIb)	18.2 (2/11: 2 II)
Disease-free survival rate	100 (10/10)	100 (11/11)

AE: Alveolar echinococcosis; CE: Cystic echinococcosis; ELRA: Ex vivo liver resection and autotransplantation; NOC: Non-opened cyst; OC: Opened cyst; PN: Partial nephrectomy; TN: Total nephrectomy; IVC: Inferior vena cava; PV: Portal vein; OP: Operative.