Modified endocystectomy versus pericystectomy in echinococcus granulosus liver cysts: a randomized controlled study and the role of specific anti-hydatid iGG4 in detection of early recurrence

The evidence based data of hydatid liver disease indicate that the level of evidence was too low to help decide between radical or conservative surgeries [level IV evidence, grade C recommendation]. So, there is a need for accurately designed randomized trials with precise goals to compare pericystes-tomy versus a specific modified endocystectomy technique for the treatment of hepatic hydatid cysts 8 cm or less in diameter in Egyptian patients, regarding the operative time, intra-opera-tive blood loss, complications and long term recurrence and to test the role of anti-hydatid IgG4 in diagnosis and detection of early recurrence. 60Patients with 131 liver cysts of E. granu-losus fulfilling the study criteria were randomly divided to two groups. G1: 32 patients with 69custs treated by modified endo-cystectomy and GII: 28 patients with 62cysts treated by closed total pericystectomy. GIa included 40cysts >5cm in diameter [mean 6.86, SD +/- 0.809] and GIb29cysts5cm in diame-ter [mean 7.01 SD +/- 0.79] and GIIb25cysts >/-cm in diameter [mean 4.04 SD +/- 0.93]. Preoperative evaluation inclyded histo-ry taking, clinical examination, blood tests, specific anti-hydat-id IgG4, abdominal sonography and CT scan. The operative time for dealing with each cyst was in minutes. Operative blood loss and need for blood trancfusion were estimated for each patient. Specific anti-hydatid IgG4 by ELISA was used to diagnose and to detect early rasurrence. Patients were followed up clinically and by ultrasonography every 3 months and for anti-hydatid IgG4 every 6 months for 24-90 months. The mean maximum operative time was in GIIa followed by GIa, GIb, then GIIb. The operative time was significantly lower in GIIb than Ib and in GIa than IIa. Seven patients [GII] had blood transfusion. The intraoperative bleeding in GI was <500ml/patient, and 18patients [GII] each bled >500ml. No intra-peritoneal seedling during the follow up. Five of 55patients [9%] were serologically suspected of relapse or incomplete cure. One [GII] showed early recurrence at 3 months. High IgG4 antibodies were detected in patients which decreased gradually after surgery and normal after 18 months post-operation.

Pre-operative MRI evaluation of local disease extent in residual / recurrent colorectal and anal cancer

To determine pre-operative MRI accuracy in assessing local disease extent in residual / recurrent colorectal and anal cancer by comparing MRI assessment and staging examination under anaesthesia, Eighteen consecutive patients with recurrent [12 patients] or residual [6 patients] underwent examination under anaesthesia and MRI using a phased array pelvic coil. .Analysis of eight specific anatomical regions for tumor involvement on MRI was performed Findings at examination under anaesthesia and biopsy were recorded. The MRI and examination under anaesthesia findings were correlated with findings at surgery and histopathology. MRI accuracy in determining tumor invasion for all sites assessed were [90%,], sensitivity was [85%,], specificity was [91%], positive predictive value [PPV] was [75%] and negative predictive value [NPV] was [95%]. For those anatomical sites evaluated by both examination under anaesthesia and MRI, MRI was superior to examination under anaesthesia, with an accuracy of 90% Vs 74%. MRI is an accurate technique for assessing disease extent in recurrent / residual colorectal and anal cancer