Predictors of Recurrence After Surgery for Hepatic Hydatid Cysts: Survival Analysis and Risk Modeling from an Endemic Region

BACKGROUND: Hepatic cystic echinococcosis remains endemic in many regions, and surgery is the mainstay of treatment. However, postoperative recurrence remains a significant concern. This study aimed to identify predictors of recurrence after surgical management. METHODS: We conducted a retrospective study including patients who underwent surgery for hepatic hydatid cysts between 2010 and 2022 in a tertiary center in Tunisia. Clinical, radiological, and operative variables were analyzed. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method and compared with the log-rank test. All variables were first assessed in univariate analysis; those with p < 0.10 were entered into a multivariable Cox regression model to identify independent predictors. RESULTS: A total of 117 patients were included. After a mean follow-up of 32 ± 14 months (median 30 IQR 18-44), recurrence occurred in 9 patients (7.7%). In multivariable analysis, cyst calcification (HR 3.6), gelatinous cyst content (HR 4.1), and absence of omentoplasty (HR 3.9) were independent predictors of recurrence. Albendazole therapy ≥3 months was associated with a reduced risk (HR 0.28). The model showed good discrimination (AUC 0.86). CONCLUSION: Recurrence after hepatic hydatid cyst surgery is influenced by cyst characteristics and operative management. A structured risk-factor analysis identified independent predictors that may guide postoperative follow-up.