Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2024; 30(23): 2981-2990
Published online Jun 21, 2024. doi: 10.3748/wjg.v30.i23.2981
Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis: A retrospective study
Yilizhati Aimaitijiang, Tie-Min Jiang, Ying-Mei Shao, Tuerganaili Aji
Yilizhati Aimaitijiang, State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Yilizhati Aimaitijiang, The First Ward of Hepatobiliary and Pancreatic Surgery, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
Tie-Min Jiang, Tuerganaili Aji, Department of Hepatobiliary & Hydatid Diseases, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Ying-Mei Shao, Xinjiang Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Author contributions: Aimaitijiang Y and Aji T designed the outline of the manuscript; Jiang TM drafted the manuscript; Shao YM edited the manuscript and reviewed the literature, supervised and supported the study; Aji T revised the manuscript and provided funding support; and all authors have read and approve the final manuscript.
Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region, China, No. 2022D01D17.
Institutional review board statement: The study was approved by the Human Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University (No. 20211015-53), and conducted in accordance with the Declaration of Helsinki.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tuerganaili Aji, Doctor, PhD, Professor, Department of Hepatobiliary & Hydatid Diseases, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, No. 393 Xinyi Road, Xincheng District, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. tuergan78@sina.com
Received: January 11, 2024
Revised: May 2, 2024
Accepted: May 20, 2024
Published online: June 21, 2024
Processing time: 161 Days and 10.2 Hours
Abstract
BACKGROUND

Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis (AE). Currently, there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial. Radical hepatectomy combined with regional lymph node dissection is a better treatment.

AIM

To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.

METHODS

A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed. Fifty-five patients with combined lymph node metastasis were analysed for their clinical data, diagnosis and treatment methods, follow-up efficacy, and characteristics of lymph node metastasis. Finally, we comparatively analysed the lymph node metastasis rates at different sites. Categorical variables are expressed as frequencies and percentages, and the analysis of difference was performed using the χ2 test. The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.

RESULTS

A lymph node metastasis rate of 8.8% (55/623) was reported in patients with hepatic AE, with a female predilection (69.1%) and a statistically significant sex difference (χ2 = 8.018, P = 0.005). Of the 55 patients with lymph node metastasis, 72.7% had a parasite lesion, neighbouring organ invasion, and metastasis stage of P3N1M0 and above, of which 67.3%, 78.2%, and 34.5% of hepatic AE lesions invaded the bile ducts, blood vessels, and distant metastases, respectively. Detection rates of lymph node metastasis of 16.4%, 21.7%, and 34.2% were reported for a preoperative abdominal ultrasound, magnetic resonance imaging, and computed tomography examinations. All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection. After surgery, a routine pathological examination was conducted on the resected lymph nodes. A total of 106 positive lymph nodes were detected in six groups at various sites, including 51 single-group metastasis cases and four multi-group metastasis cases. When the metastasis rates at different sites were statistically analysed, we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites (χ2 = 128.089, P = 0.000 < 0.05). No statistical difference was observed in the metastasis rate between the five other groups. Clavien-Dindo grade IIIa complication occurred in 14 cases, which improved after administering symptomatic treatment. Additionally, lymph node dissection-related complications were not observed. Recurrence after 2 years was observed in one patient.

CONCLUSION

Lymph node metastasis is a rare form of metastasis in hepatic AE, which is more frequent in women. Para-hepatoduodenal ligament lymph nodes are commonly observed. Radical hepatectomy combined with regional lymph node dissection is a safe, effective, and feasible treatment for liver AE combined with lymph node metastasis.

Keywords: Echinococcosis; Radical hepatectomy; Lymph node metastasis; Lymph node dissection; Alveolar echinococcosis; Hepatic

Core Tip: We retrospectively summarized and analyzed the clinical data, diagnosis and treatment, follow-up efficacy and characteristics of lymph node metastasis in 55 patients combined with lymph node metastasis among 623 patients with hepatic alveolar echinococcosis (AE) admitted to our hospital from January 2012 to January 2022. This study is the first and largest retrospective study specifically describing the management of hepatic AE combined with lymph node metastases. We present a radical hepatectomy combined with regional lymph node dissection strategy for patients with hepatic AE combined with lymph node metastasis based on the outcomes of this study and our experience.