RESUMO
BACKGROUND: Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe. METHODS: 61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols' application. RESULTS: The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups' stratification. CONCLUSION: The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes.
RESUMO
Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rare and its primary involvement occurs in less than 2% of cases. We report a case of primary giant splenic and hepatic hydatid cyst in a 28-year-old woman who was admitted for upper right quadrant pain. The abdominal ultrasonography and computed tomography showed two cystic tumors with hydatid features in liver and spleen. Total splenectomy was performed for the splenic cyst and partial pericystectomy with drainage for the liver cyst using a laparoscopic approach. One drain was kept in place for two months due to a biliary leak of about 20 ml/day and removed afterward. The patient was discharged on postoperative day 7. Laparoscopic approach for patients with concomitant splenic and hepatic hydatidosis is a safe and effective option.