Place of major resection in treatment of pulmonary hydatid cyst: report of 403 cases

Abstract

Background: Echinococcosis is an endemic disease in the Mediterranean region. It occurs in rural areas and constitutes a real public health problem.

Methods: We performed a retrospective study including patients who underwent major resection for pulmonary hydatid cysts between January 1993 and september 2019.

Results: During the study period, 2966 patients were operated on for pulmonary hydatid cysts, 403 of whom had a major resection. There were 192 male (48%) and 211 female (52%) with a mean age of 27 years (range 4-86 years). Of the cysts, 238 were localised in the right lung (60%), 161 in the left lung (39.99%) and 4 patients (0.01%) had bilateral cysts. Isolated pulmonary hydatid cyst was seen in 346 patients, while 54 patients had combined pulmonary and hepatic cysts. Two patients had renal hydatid cyst and one patient had a splenic cyst. Posterolateral thoracotomy was the main approach (395 patients).The surgical procedure was lobectomy in 319 cases, segmentectomy in 69 cases, bilobectomy in 14 cases and pneumonectomy in one case. Follow-up was uneventful for 338 cases. Postoperative complications occured in 65 patients: The most common were atelectasis, pneumothorax and infection. There were four deaths. We compared postoperative outcomes between patients who underwent major resection and those who had conservative surgery. We did not find a significant difference (p= 0.07).

Conclusion: Treatment of pulmonary hydatid cyst is mainly surgical.The choice of surgical technique is most often influenced by the patient's condition, size of the cyst, adjacent pulmonary parenchyma and the respiratory function.