Minimally invasive versus open liver resection for hepatic alveolar echinococcosis within a disease-control oriented surgical strategy: a single-center retrospective study.

BACKGROUND: The surgical strategy for hepatic alveolar echinococcosis (AE) differs from that for typical malignant tumors, as treatment is not solely determined by the feasibility of complete (R0) resection. While complete resection remains the preferred goal, cytoreductive surgery combined with albendazole therapy is considered in selected cases. The role of minimally invasive surgery (MIS) within this disease-control oriented strategy remains unclear. METHODS: We retrospectively analyzed 126 patients who underwent liver resection for hepatic AE between January 2010 and March 2026: 87 underwent open surgery and 39 underwent MIS. Perioperative and disease-control outcomes were compared, with propensity score overlap weighting used to adjust for baseline differences. RESULTS: The MIS group had smaller lesions and less advanced disease. Operative time was similar, whereas blood loss, Clavien-Dindo grade ≥II morbidity, severe morbidity, and hospital stay were lower in the MIS group. After overlap weighting, MIS was not associated with an increased hazard of disease progression (hazard ratio 0.47, 95% confidence interval 0.07-3.22; p=0.44). An adjusted hazard ratio for overall survival was not estimable because no deaths occurred in the MIS group. CONCLUSIONS: In selected patients with hepatic AE, MIS was associated with favorable perioperative outcomes. Although no increased risk of disease progression was detected after adjustment, limited events and shorter follow-up preclude conclusions regarding long-term equivalence.