Cystic echinococcosis (CE) is a globally distributed zoonotic disease caused by the Echinococcus Granulosus sensu lato species complex. When addressing Pulmonary echinococcosis, three primary treatment approaches exist surgery, chemotherapy employing albendazole, and a watch-and-wait strategy. While surgery stands as the conventional treatment for intrathoracic echinococcal cysts, ongoing discussions persist regarding the most effective surgical technique. Various options are available, including lobectomy, segmentectomy, or direct cyst removal. The selection among these techniques relies on multiple factors such as the integrity of the cyst, its number, location within the lung, and any associated damage to lung tissue. Each surgical approach carries its unique considerations and potential benefits, and the choice among them depends on a careful assessment of the individual patient's condition and the expertise of the medical team involved. In this study, we aimed to provide a detailed evaluation of the surgical techniques and economic burden of thoracic echinococcosis by analyzing hospitalization costs and surgical approaches of 9 patients admitted to the Thoracic Surgery Ward at “Santi Antonio e Biagio e Cesare Arrigo” Hospital of Alessandria throughout 2023. We found that the total cost of a single hospitalization including hospital stay and surgical intervention, ranged from €7754,387 to €19160,987 (median: €12037,157, mean: €12789,011). The main surgical approach was the cystostomy with closure of bronchial openings and capitonnage. In this study, we have determined that adhering to a more conservative approach, like cystostomy, yields better surgical outcomes, corroborating findings in existing literature. Although cystostomy may incur a slightly higher cost, the benefits it offers outweigh this marginal difference in expense. Given the relatively comparable costs between the two procedures, favoring the more conservative surgery emerges as the prudent choice. Therefore, based on our analysis, despite the minimal cost disparity, opting for cystostomy remains the preferred surgical approach.
L'echinococcosi cistica (CE) è una malattia infettiva diffusa a livello globale causata dal parassita Echinococcus Granulosus. Per quanto riguarda l'echinococcosi polmonare, ci sono tre principali modi per trattarla: la chirurgia, la chemioterapia con albendazolo e l'approccio "watch-and-wait". Anche se la chirurgia è considerata il trattamento tradizionale per le cisti polmonari, ci sono ancora dibattiti su quale tecnica chirurgica sia la più efficace. Diverse opzioni sono disponibili, come la lobectomia, la segmentectomia e la rimozione diretta della cisti. La decisione su quale tecnica utilizzare dipende da vari fattori come le caratteristiche della cisti, il numero di cisti, la loro posizione nel polmone e eventuali danni al tessuto polmonare. Ogni approccio chirurgico ha aspetti positivi e considerazioni uniche, e la scelta dipende dalla valutazione dettagliata della situazione del paziente e dall'esperienza dell’equipe chirurgica. Nel nostro studio, condotto presso il reparto di Chirurgia Toracica dell'Ospedale "Santi Antonio e Biagio e Cesare Arrigo" di Alessandria nel corso del 2023, sono stati analizzati i costi di ricovero e gli approcci chirurgici di 9 pazienti affetti da echinococcosi toracica. È emerso che il costo totale di un ricovero, comprensivo di degenza e intervento chirurgico, variava da 7754.387 a 19160.987 euro (media: 12789.011 euro, mediana: 12037.157 euro). L'approccio chirurgico predominante è stato la cistostomia con chiusura delle aperture bronchiali e capitonnage. In linea con quanto riportato nella letteratura scientifica, la nostra analisi ha dimostrato che l'adesione a un approccio conservativo come la cistostomia porta a risultati chirurgici migliori. Nonostante i potenziali costi leggermente più elevati legati alla cistostomia, i benefici ottenuti superano questa lieve differenza economica. Poiché i costi delle due procedure sono relativamente simili, la scelta più saggia sarebbe quella di privilegiare l'intervento meno invasivo. Dunque, in base ai risultati del nostro studio, nonostante la modesta differenza di spesa, la cistostomia rimane l'approccio chirurgico consigliato.
Surgical Techniques and Cost Analysis associated with Pulmonary Echinococcosis: A Single-Center Experience
PELIZZOLA, MATILDE
2023/2024
Abstract
Cystic echinococcosis (CE) is a globally distributed zoonotic disease caused by the Echinococcus Granulosus sensu lato species complex. When addressing Pulmonary echinococcosis, three primary treatment approaches exist surgery, chemotherapy employing albendazole, and a watch-and-wait strategy. While surgery stands as the conventional treatment for intrathoracic echinococcal cysts, ongoing discussions persist regarding the most effective surgical technique. Various options are available, including lobectomy, segmentectomy, or direct cyst removal. The selection among these techniques relies on multiple factors such as the integrity of the cyst, its number, location within the lung, and any associated damage to lung tissue. Each surgical approach carries its unique considerations and potential benefits, and the choice among them depends on a careful assessment of the individual patient's condition and the expertise of the medical team involved. In this study, we aimed to provide a detailed evaluation of the surgical techniques and economic burden of thoracic echinococcosis by analyzing hospitalization costs and surgical approaches of 9 patients admitted to the Thoracic Surgery Ward at “Santi Antonio e Biagio e Cesare Arrigo” Hospital of Alessandria throughout 2023. We found that the total cost of a single hospitalization including hospital stay and surgical intervention, ranged from €7754,387 to €19160,987 (median: €12037,157, mean: €12789,011). The main surgical approach was the cystostomy with closure of bronchial openings and capitonnage. In this study, we have determined that adhering to a more conservative approach, like cystostomy, yields better surgical outcomes, corroborating findings in existing literature. Although cystostomy may incur a slightly higher cost, the benefits it offers outweigh this marginal difference in expense. Given the relatively comparable costs between the two procedures, favoring the more conservative surgery emerges as the prudent choice. Therefore, based on our analysis, despite the minimal cost disparity, opting for cystostomy remains the preferred surgical approach.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/17175