{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T08:14:53Z","timestamp":1789892093391,"version":"4.0.1"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>(1) Background: Alveolar echinococcosis (AE) is an ultimately fatal disease, whose only curative treatment is surgery. Due to its late presentation extended liver resections are often necessary. The true benefit of extensive surgery has yet to be established; (2) Methods: We present a single center experience of 33 cases of Echinococcus multilocularis that have been treated at a high-volume hepatobiliary surgery center between 2004 and 2021. (3) Results: Of the 33 patients 24 patients underwent major liver resection (73%). In addition to the liver resection patients frequently underwent complex extrahepatic procedures such as lymphadenectomy (n = 21, 61%), vascular resections and reconstructions (n = 9, 27%) or resections and reconstruction of the extrahepatic bile duct (n = 11, 33%). Seven patients suffered from \u2265 grade III complications (21%). Complete resection was achieved in 17 patients. Fourteen patients had R1 resections and two had macroscopic parasitic remnant (R2). Progressive disease was reported in three patients (The two R2 patients and one R1 resected patient). At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE. Even in extensive disease the combination of complex resection and perioperative benzimidazoles can achieve favorable long-term outcomes.<\/jats:p>","DOI":"10.3390\/pathogens11010040","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T20:49:38Z","timestamp":1641242978000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Alveolar Echinococcosis\u2014A Challenging Task for the Hepatobiliary Surgeon"],"prefix":"10.3390","volume":"11","author":[{"given":"Jens","family":"Strohaeker","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaly","family":"Sulyok","sequence":"additional","affiliation":[{"name":"Department of Pathology and Neuropathology, University Hospital Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Koenigsrainer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8803-6670","authenticated-orcid":false,"given":"Silvio","family":"Nadalin","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/bs.apar.2016.11.001","article-title":"Global Distribution of Alveolar and Cystic Echinococcosis","volume":"95","author":"Deplazes","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/clinids\/15.2.234","article-title":"Parasiticidal Effect of Chemotherapy in Alveolar Hydatid Disease: Review of Experience with Mebendazole and Albendazole in Alaskan Eskimos","volume":"15","author":"Wilson","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S0889-8553(05)70268-5","article-title":"Cestodes. Echinococcus","volume":"25","author":"Ammann","year":"1996","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_4","first-page":"323","article-title":"Swiss study of chemotherapy of alveolar echinococcosis--review of a 20-year clinical research project","volume":"129","author":"Ammann","year":"1999","journal-title":"Schweiz. Med. Wochenschr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/bs.apar.2016.07.003","article-title":"Historical Aspects of Echinococcosis","volume":"95","author":"Eckert","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jhep.2008.03.023","article-title":"Alveolar echinococcosis: From a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years","volume":"49","author":"Torgerson","year":"2008","journal-title":"J. Hepatol."},{"key":"ref_7","first-page":"Doc01","article-title":"Comprehensive diagnosis and treatment of alveolar echinococcosis: A single-center, long-term observational study of 312 patients in Germany","volume":"5","author":"Kern","year":"2017","journal-title":"GMS Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/bs.apar.2016.09.006","article-title":"The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease","volume":"96","author":"Kern","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s15010-017-1094-0","article-title":"Alveolar echinococcosis in Germany, 1992\u20132016. An update based on the newly established national AE database","volume":"46","author":"Schmidberger","year":"2018","journal-title":"Infection"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.3201\/eid1812.120219","article-title":"Westward Spread of Echinococcus multilocularis in Foxes, France, 2005\u20132010","volume":"18","author":"Combes","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"878","DOI":"10.3201\/eid1306.061074","article-title":"Human Alveolar Echinococcosis after Fox Population Increase, Switzerland","volume":"13","author":"Schweiger","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e000036","DOI":"10.1136\/bmjgast-2015-000036","article-title":"Pitfalls in diagnosis and treatment of alveolar echinococcosis: A sentinel case series","volume":"2","author":"Stojkovic","year":"2015","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s00104-019-1001-6","article-title":"Diagnostik und Management der intraabdominellen Echinococcus-Manifestation","volume":"90","author":"Nadalin","year":"2019","journal-title":"Der Chir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jhep.2021.02.015","article-title":"Parasites of the liver\u2014Epidemiology, diagnosis and clinical management in the European context","volume":"75","author":"Peters","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.crad.2019.01.007","article-title":"Hepatic alveolar hydatid disease (Echinococcus multilocularis), a mimic of liver malignancy: A review for the radiologist in non-endemic areas","volume":"74","author":"Chouhan","year":"2019","journal-title":"Clin. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"811","DOI":"10.4269\/ajtmh.18-0609","article-title":"Echinococcosis and Albendazole: A Case for Suitable Treatment","volume":"99","author":"Horton","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E756","DOI":"10.1111\/ans.14475","article-title":"Liver resection in octogenarians: Are the outcomes worth the risk?","volume":"88","author":"Gupta","year":"2018","journal-title":"ANZ J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.actatropica.2009.11.001","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010","journal-title":"Acta Trop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S283","DOI":"10.1016\/j.parint.2005.11.041","article-title":"WHO classification of alveolar echinococcosis: Principles and application","volume":"55","author":"Kern","year":"2006","journal-title":"Parasitol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S113","DOI":"10.1017\/S0031182000007290","article-title":"Albendazole: A review of anthelmintic efficacy and safety in humans","volume":"121","author":"Horton","year":"2000","journal-title":"Parasitology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s00423-018-1687-9","article-title":"Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis","volume":"403","author":"Hillenbrand","year":"2018","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Grimm, J., Nell, J., Hillenbrand, A., Henne-Bruns, D., Schmidberger, J., Kratzer, W., Gruener, B., Graeter, T., Reinehr, M., and Weber, A. (2020). Immunohistological detection of small particles of Echinococcus multilocularis and Echinococcus granulosus in lymph nodes is associated with enlarged lymph nodes in alveolar and cystic echinococcosis. PLoS Neglected Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008921"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1007\/s00268-016-3813-6","article-title":"Impact of Safe Distance on Long-Term Outcome After Surgical Therapy of Alveolar Echinococcosis","volume":"41","author":"Hillenbrand","year":"2016","journal-title":"World J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.jamcollsurg.2011.02.007","article-title":"Long-Term Results of Hepatectomy for Patients with Alveolar Echinococcosis: A Single-Center Experience","volume":"212","author":"Kawamura","year":"2011","journal-title":"J. Am. Coll. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S1365-182X(17)30755-4","article-title":"The Brisbane 2000 Terminology of Liver Anatomy and Resections","volume":"2","author":"Strasberg","year":"2000","journal-title":"HPB"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.surg.2010.10.001","article-title":"Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)","volume":"149","author":"Rahbari","year":"2011","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1245\/s10434-019-08192-z","article-title":"ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-Center Study","volume":"27","author":"Li","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"69","DOI":"10.21037\/tgh.2018.09.01","article-title":"Resection for Klatskin tumors: Technical complexities and results","volume":"3","author":"Capobianco","year":"2018","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4269\/ajtmh.2002.66.23","article-title":"Combined ultrasound and serologic screening for hepatic alveolar echinococcosis in central China","volume":"66","author":"Bartholomot","year":"2002","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/BF02934492","article-title":"Contribution of mass screening system to resectability of hepatic lesions involving Echinococcus multilocularis","volume":"32","author":"Sato","year":"1997","journal-title":"J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/00042737-200012030-00011","article-title":"A twenty-year history of alveolar echinococcosis: Analysis of a series of 117 patients from eastern France","volume":"12","author":"Vuitton","year":"2000","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_32","first-page":"231","article-title":"Guidelines for treatment of cystic and alveolar echinococcosis in humans","volume":"74","author":"Eckert","year":"1996","journal-title":"Bull. World Health Organ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1002\/hep.20078","article-title":"Structured treatment interruption in patients with alveolar echinococcosis","volume":"39","author":"Reuter","year":"2004","journal-title":"Hepatology"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Tamarozzi, F., Horton, J., Muhtarov, M., Ramharter, M., Siles-Lucas, M., Gruener, B., Vuitton, D.A., Bresson-Hadni, S., Manciulli, T., and Brunetti, E. (2020). A case for adoption of continuous albendazole treatment regimen for human echinococcal infections. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008566"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/jac\/46.3.451","article-title":"Benzimidazoles in the treatment of alveolar echinococcosis: A comparative study and review of the literature","volume":"46","author":"Reuter","year":"2000","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/BF00930903","article-title":"Improvement of liver resectional therapy by adjuvant chemotherapy in alveolar hydatid disease","volume":"77","author":"Ammann","year":"1991","journal-title":"Parasitol. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e00057","DOI":"10.1016\/j.fawpar.2019.e00057","article-title":"Surgery versus conservative drug therapy in alveolar echinococcosis patients in Germany\u2014A health-related quality of life comparison","volume":"16","author":"Schmidberger","year":"2019","journal-title":"Food Waterborne Parasitol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s00423-008-0392-5","article-title":"Long-term experience on surgical treatment of alveolar echinococcosis","volume":"394","author":"Buttenschoen","year":"2009","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/ans.14937","article-title":"Liver resection in octogenarians: Are the outcomes worth the risk? The Hamburg Barmbek experience","volume":"89","author":"Makridis","year":"2019","journal-title":"ANZ J. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/j.1477-2574.2012.00440.x","article-title":"Evaluating agreement regarding the resectability of colorectal liver metastases: A national case-based survey of hepatic surgeons","volume":"14","author":"Mohammad","year":"2012","journal-title":"HPB"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1503\/cjs.014616","article-title":"Assessing resectability of colorectal liver metastases: How do different subspecialties interpret the same data?","volume":"61","author":"Aubin","year":"2018","journal-title":"Can. J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100049","DOI":"10.1016\/j.lanepe.2021.100049","article-title":"Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study","volume":"3","author":"Osterlund","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s00423-008-0367-6","article-title":"Palliative operation for the treatment of alveolar echinococcosis","volume":"394","author":"Buttenschoen","year":"2008","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ijsu.2016.09.094","article-title":"Hepatectomy for patients with alveolar echinococcosis: Long-term follow-up observations of 144 cases","volume":"35","author":"Du","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"680","DOI":"10.4269\/ajtmh.16-0557","article-title":"Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases","volume":"96","author":"Qu","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.hpb.2019.08.003","article-title":"Individualized biliary reconstruction techniques in autotransplantation for end-stage hepatic alveolar echinococcosis","volume":"22","author":"Zeng","year":"2020","journal-title":"HPB"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1055\/s-0041-1730925","article-title":"Hepatic Alveolar Echinococcosis","volume":"41","author":"Spahr","year":"2021","journal-title":"Semin. Liver Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/1\/40\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:56:33Z","timestamp":1760169393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/1\/40"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,31]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["pathogens11010040"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11010040","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,31]]}}}