palliative operations such as marsupialization with biliary drainage, Patients with alveolar echinococcosis of the liver and laparotomy were performed in 14, 5, and 1 cases, respectively.
(AEL) can be cured by complete excision of the lesions;
Mebendazole had been given before albendazole therapy in 9 cases. however, it is not always completely resectable in ad-Eight patients had lung metastasis, and 2 had lymph node metasta- vanced cases. Recently, benzimidazole-type drugs have sis. The staging system proposed by Nakajima et al. 10 was used. been reported to be effective in nonresectable AEL. One Five groups (I, II, IIIa, IIIb, and IV) are obtained according to three hundred fifty-two patients with AEL have been surgiprincipal degrees of anatomic extent: apparent localization of the cally treated in our institution since 1937. Our clinical site of origin (occupied segments); evidence of regional spread to the adjacent tissue or organ, usually in the form of direct invasion; and trial with albendazole, one of the benzimidazole carbasigns of dissemination beyond the regional extent, or distant metasmates, has included 26 cases of AE since September 1988, tasis. Stages I to IIIa indicate progressive occupation of primary each of whom had undergone an operation. Complete lesions from one to three segments of the liver, having neither invaresection was performed in only six cases. Evaluation of sion to the adjacent tissue or organ nor distant metastasis. Stage
response to the treatment was possible in 20 cases. A IIIb indicates, in addition to involvement of one to three segments, favorable response to albendazole, such as decreases in regional tissue or organ invasion and/or distant metastasis, but all the size of the lesions, changes in cyst morphology, and lesions should be resectable. Stage IV indicates intrahepatic lesions amelioration in clinical symptoms or signs, was achieved occupied in four segments and/or regional invasion and/or distant in 11 (55%) cases. These favorable responses were also metastasis of which every lesion is nonresectable (i.e., curative opera- tion cannot be achieved). 10 Advanced stages were seen frequently; seen in cases of noncurative resection and palliative opthere were 1, 3, 4, 6, and 12 cases in stages I, II, IIIa, IIIb, and IV, eration. The cumulative survival rate of the patients was respectively.
87%, 15 years after the operation. A complete response
Hematological examination and liver function tests were perwas achieved in one case; the residual lesion in the liver formed every 2 weeks, and serological tests and ultrasound (US) and completely disappeared on the computed tomography computed tomography (CT) scans were carried out at approximately image 3.5 years after noncurative surgery. Palliative or 6-month intervals. The drug protocol for albendazole (200-mg tablets; mass reduction surgery combined with albendazole obtained from SmithKline Beecham, Tokyo, Japan) was 10 mg/kg/d therapy may be a strategy for advanced disease, espeorally in a treatment cycle of 4 weeks with 2-week breaks. 3 This cycle cially when complete resection might result in signifiwas repeated indefinitely unless there were adverse reactions. The average duration of treatment was 3.25 years.
RESULTS