Comparative Outcomes of Radical Surgery, Conservative Surgery, and Percutaneous Treatment for Active Hepatic Cystic Echinococcosis: A Retrospective Cohort Study

BACKGROUND: Treatment of active hepatic cystic echinococcosis (CE) depends on cyst stage and clinical features. Comparative outcomes of radical surgery, conservative surgery, and percutaneous treatment remain uncertain. We compared outcomes across these strategies in a single-center cohort. METHODS: We retrospectively reviewed adults treated at a tertiary-care center in Karnataka, India, between January 2020 and December 2024. Patients were grouped by definitive intervention: radical surgery (n = 15), conservative surgery (n = 18), or percutaneous puncture, aspiration, injection, and re-aspiration (PAIR) (n = 8). Outcomes included treatment success, complications, hospital stay, and recurrence. RESULTS: World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) stage distribution differed among groups (p < 0.001): CE3b (daughter cysts within a solid matrix) accounted for 80.0% of the radical group, 55.6% of the conservative group, and 25.0% of the PAIR group. Treatment success was observed in 15/15 patients (100.0%) after radical surgery, 15/18 (83.3%) after conservative surgery, and 4/8 (50.0%) after PAIR (p = 0.007). Complications occurred in 2/15 (13.3%), 6/18 (33.3%), and 5/8 (62.5%), respectively (p = 0.038). Mean hospital stay was 6.1, 9.8, and 3.5 days, respectively (p < 0.001). Recurrence occurred in 0/15, 2/18 (11.1%), and 2/8 (25.0%). CONCLUSION: Radical surgery had the highest observed treatment success and no recorded recurrence in this cohort. Because treatment groups differed by cyst stage and treatment was not randomized, these findings are exploratory and do not establish comparative superiority.