[Extended Liver Resection with Complex Vascular Reconstruction in Locally Advanced Alveolar Echinococcosis]

Hepatic echinococcosis is rare in Germany. Liver resection is a potentially curative treatment, if a complete resection according to oncological standards can be achieved. Due to the infiltrating growth of E. multilocularis, liver resections can be challenging.

We present a case of hepatic echinococcosis with complete infiltration of left and middle hepatic vein and a partial infiltration of the right hepatic vein (RHV) and the vena cava (VCI). To better evaluate resectability, we performed a three-dimensional reconstruction based on the preoperative CT scan. Complete resection was achieved with an extended left hemihepatectomy (removal of segment 1-5 and partially segment 8) and tangential resection of the VCI and partial resection of the RHV. VCI was reconstructed with a bovine pericardial patch and the RHV was reconstructed end-to-end.

Liver resection may require complex vascular resections and reconstructions to achieve an R0 situation in the therapy of E. multilocularis. Three dimensional planning of the resection facilitated curative resection in the current case.