Echinococcus granulosus Genotype and Surgical Outcomes After Cystic Echinococcosis Surgery: A Propensity-Score-Adjusted Retrospective Pilot Cohort Study

Background: Echinococcus granulosus sensu lato comprises several genotypes (G1, G3, G6–G10) that may differ in host range and clinical phenotype, but whether genotype influences localization, cyst size/stage, surgical complexity, or recurrence after cystic echinococcosis (CE) surgery has not been empirically tested; this analysis is accordingly exploratory and hypothesis-generating. Methods: We retrospectively analyzed 80 patients who underwent CE surgery (March 2022–March 2026) with intraoperative genotyping. After excluding eight patients with missing baseline data, a propensity-score-adjusted comparison (age, sex, preoperative albendazole use) compared G1 (n = 57) against pooled non-G1 genotypes (n = 15) in the 72-patient analytic cohort; because the eligible non-G1 pool was smaller than the matching target, the algorithm retained the entire cohort rather than producing matched pairs. Localization, cyst size/WHO-IWGE stage, surgical difficulty, and recurrence-free survival were compared (effect sizes with 95% CIs alongside p-values), with a post hoc sensitivity analysis in the full unmatched cohort (n = 80). Results: G1 and non-G1 groups were balanced for age, sex, and antiparasitic pretreatment; cyst multiplicity showed residual imbalance. Intraoperative spillage (33.3% vs. 12.3%; RR 2.71, 95% CI 0.99–7.35) and recurrence (33.3% vs. 17.5%; RR 1.90, 95% CI 0.76–4.72) were numerically higher in non-G1 but not statistically significant (p = 0.111, p = 0.281); no other domain differed significantly. In the unmatched cohort, spillage reached nominal significance (37.5% vs. 12.5%; p = 0.029), while recurrence did not (p = 0.077). Conclusions: Non-G1 genotypes showed potentially higher point estimates for spillage and recurrence, but the evidence was imprecise and insufficient to establish a genotype–outcome association; adequately powered, prospectively genotyped, multi-center studies are needed.