Surgical management of hepatic cystic echinococcosis – a 20-year case series and outcome analysis

Background Cystic echinococcosis (CE) is a parasitic zoonosis, caused by the larval stage of Echinococcus granulosus, typically forming cysts in the liver. If left untreated, CE can be life-threatening. Albendazole remains the standard medical therapy, but surgical intervention is indicated in selected cases. Methodology/Principal Findings We conducted a retrospective, multicenter outcome analysis in Switzerland of surgically treated hepatic cystic echinococcosis from 2004 to 2024. Thirty-one patients with CE stages I-III who underwent pericystectomy, endocystectomy, or minimally invasive procedures were included. The primary objective was to evaluate the safety and efficacy of surgical treatment. Data on patient demographics, disease characteristics, and perioperative morbidity and mortality, as well as recurrence rates stratified by surgical technique were analyzed. All patients received adjuvant albendazole therapy for a median duration of 4 months (3–204 months). Across 32 surgical interventions, most patients (81.3%; n=26) had one or two cysts (1–8), with a median cyst size of 8 cm (3–19 cm). The median follow-up was 78 months (12–230 months). The overall recurrence rate was 6.3% (n=2); however, there were no recurrences observed after pericystectomy (n= 0) or endocystectomy (n=0). The 90-day postoperative mortality rate was 0%. Conclusions In combination with established pharmacological therapy, surgery remains a safe and effective treatment option for CE, associated with low recurrence and negligible perioperative mortality. Surgical therapy should be considered a valuable component of CE management, especially in patients who are not optimal candidates for antihelmintic therapy alone.