PURPOSE: Thoracic echinococcosis is an important problem in endemic areas, with significant morbidity related to this disease. We present a retrospective analysis of a single-center experience.
METHODS: Between 01.01.1985-01.01.2007 we treated 212 patients with thoracic echinococcosis. Average age was 52, ranges 5 and 76 years, with a sex ratio M/F of 3/1. The proportion of complicated (suppurated) / non-complicated cysts was 111/101; 15 patients presented secondary echinococcosis –13 after previous surgery and 2 posttraumatic. 6 patients presented bilateral pulmonary cysts and 8 patients presented associated hepatic hydatid disease. The procedures used were: ideal cystectomy - 32 cases, Finochietto cystectomy with pericystectomy in 152 cases, non-anatomic resection in 20 cases and lobectomy in 8 cases. The residual cavity was treated through cappitonage with late resorbable suture, without direct closure of the bronchial fistulae (if present). All the procedures were performed by the same surgical team.
RESULTS: Major morbidity was encountered in 20 cases: residual cavities requiring reoperation in 6 cases, postoperative hemorrhage in one case, respiratory failure in 2 cases, renal failure in 3 cases, heart failure in 2 cases, wound suppuration in 6 cases; 3 patients developed anaphylactic shock requiring resuscitation. Overall mortality was 1,42 (3 patients), with a major difference between primary versus secondary echinococcosis (0,5% versus 13,3%, p<0,05). Presence of cyst suppuration had a significant influence on the hospitalisation (average of 20 versus 11 days, p<0,05). The procedure used to treat the hydatid cyst, presence of bilateral pulmonary or associated hepatic lesions had no statisticaly significant impact on the postoperative evolution. Late recurrence was encountered in 5 cases. There were no significant late sequelae, with return to normal life in all 209 survivors.
CONCLUSION: Thoracic echinococcosis has a good outcome in the absence of complications; if the first surgical procedure fails to remove all the cysts or to avoid spillage of the hydatid liquid, development of secondary echinococcosis worsens the prognosis.
CLINICAL IMPLICATIONS: In experienced centers, surgery for thoracic echinococcosis can be performed with minimal morbidity and mortality.
DISCLOSURE: Alexandru Botianu, None.