Surgical management of hepatic echinococcosis - a practical approach and experience from a tertiary center

Hepatic echinococcosis is a rare parasitic disease, with the incidence of the alveolar form increasing in Central Europe in recent years. Cystic and alveolar echinococcosis differ substantially in their biological behavior and management. The aim of this study is to provide an overview of the current literature and to present the experience from a tertiary center with the surgical treatment of this disease. The study combines a review from the literature with a retrospective analysis of patients who underwent surgical treatment at the University Hospital Hradec Králové between January 2022 and February 2025. Six patients were included, five of whom had alveolar echinococcosis. Half of the patients were asymptomatic at the time of diagnosis. The in-hospital course was uncomplicated in all patients; one pulmonary embolism was recorded within the 90-day morbidity period, and 90-day mortality was zero. All patients underwent long-term follow-up in collaboration with the Department of Infectious Diseases. Treatment of cystic echinococcosis follows a stage-specific approach, and depending on the characteristics of the lesion, includes watch-and-wait, albendazole therapy, percutaneous treatment, or surgery. In resectable alveolar echinococcosis, R0 resection followed by long--term albendazole therapy is the treatment of choice, whereas lifelong albendazole therapy is indicated when R0 resection is not feasible; R1 resection is not recommended. Surgical treatment of hepatic echinococcosis in a tertiary center represents a safe and effective treatment option for selected patients, while a multidisciplinary approach and long-term follow-up remain essential.