Zhang XY, Li BQ, Cao WN, Zhang ZL, Xin Q, Jia KF. Percutaneous vs surgical management of hepatic cystic echinococcosis: A perspective on evolving clinical pathways. World J Gastroenterol 2026; 32(28): 118370 [DOI: 10.3748/wjg.118370]
Corresponding Author of This Article
Ke-Feng Jia, Department of Interventional Radiology, Central Hospital, Tianjin University/Tianjin Third Central Hospital, No. 83 Jintang Road, Hedong District, Tianjin 300170, China. jiakefeng20102@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Zhang XY, Li BQ, Cao WN, Zhang ZL, Xin Q, Jia KF. Percutaneous vs surgical management of hepatic cystic echinococcosis: A perspective on evolving clinical pathways. World J Gastroenterol 2026; 32(28): 118370 [DOI: 10.3748/wjg.118370]
Xin-Ying Zhang, Wen-Na Cao, Ke-Feng Jia, Department of Interventional Radiology, Central Hospital, Tianjin University/Tianjin Third Central Hospital, Tianjin 300170, China
Bao-Qi Li, Department of Oncology, Tianjin Third Central Hospital, Nankai University, Tianjin 300170, China
Zi-Li Zhang, Department of Gastrointestinal Oncology, Central Hospital, Tianjin University/Tianjin Third Central Hospital, Tianjin 300170, China
Qi Xin, Department of Pathology, Tianjin University/Tianjin Third Central Hospital, Tianjin 300170, China
Co-first authors: Xin-Ying Zhang and Bao-Qi Li.
Co-corresponding authors: Qi Xin and Ke-Feng Jia.
Author contributions: Zhang XY and Li BQ contributed equally to this work and are co-first authors. Zhang XY contributed to conceptualization and methodology; Zhang XY and Li BQ contributed to writing and editing; Cao WN and Zhang ZL contributed to literature screening and manuscript refinement; Xin Q and Jia KF contributed equally as co-corresponding authors. Xin Q and Jia KF provided critical revisions for scientific rigor and approved the final version. Jia KF is the primary corresponding author for all communications and administrative requirements. All authors read and approved the final manuscript.
Supported by Tianjin Science and Technology Project, No. 24JCZDJC01270; Tianjin Third Central Hospital Research Project, No. 2019YNR3; Beijing Medical Award Foundation, No. YXJL-2020-0972-1216; Tianjin Health Science and Technology Project, No. TJWJ2024MS023; and Tianjin Municipal Education Commission Scientific Research Project, No. 2025ZXZD002.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ke-Feng Jia, Department of Interventional Radiology, Central Hospital, Tianjin University/Tianjin Third Central Hospital, No. 83 Jintang Road, Hedong District, Tianjin 300170, China. jiakefeng20102@163.com
Received: December 31, 2025 Revised: February 6, 2026 Accepted: March 6, 2026 Published online: July 28, 2026 Processing time: 190 Days and 19 Hours
Abstract
The management of hepatic cystic echinococcosis continues to evolve, with percutaneous techniques increasingly challenging traditional surgical approaches. The paper from Tahtabasi et al on the recent issue of World Journal of Gastroenterology present a large-scale retrospective analysis comparing percutaneous and surgical treatments for liver hydatid cysts with a World Health Organization classification of CE1 and CE3a over a 20-year period. Their study, encompassing 989 patients from an endemic region in Türkiye, provides robust real-world evidence that percutaneous methods offer shorter hospital stays, reduced operative times, and lower risks of intraoperative organ injury, while surgical intervention demonstrates marginal advantages in reducing recollection and anaphylaxis. Importantly, the study identifies cyst volume as a key predictor of cystobiliary fistula development, irrespective of treatment modality. This editorial contextualizes these findings within the broader landscape of hydatid disease management, discusses methodological strengths and limitations, and highlights the need for standardized definitions, randomized trials, and individualized treatment algorithms. We argue that a tailored approach - incorporating cyst characteristics, anatomical location, and patient factors - is essential for optimizing outcomes in patients with this complex parasitic disease.
Core Tip: Hepatic cystic echinococcosis management is less challenged by a lack of therapeutic options than by rational, cyst-specific decision-making. Percutaneous interventions are safe and effective for cysts classified by World Health Organization as CE1 and CE3a, offering advantages in efficiency; while surgery remains essential for large cysts and those with complex biliary involvement or high-risk anatomy. Large real-world data further identify cyst volume as a major determinant of biliary complications, independent of treatment modality. Rather than competing strategies, percutaneous and surgical approaches should be integrated into dynamic, risk-adapted clinical pathways guided by cyst biology, anatomy, and procedural burden.
