Liver Diseases and Cancer Surgery
Historical Development of Liver Surgery
Surgery for Liver Diseases and Cancers | The liver has been considered a mystical and vital organ by humanity since ancient times. For this reason, liver-related diseases and surgical interventions have attracted great interest throughout history.
Antiquity and the Middle Ages
The surface anatomy of the liver (liver) was first described with clay models in Babylonia in 2000 BC
Babylon and Ancient Egypt: The liver was believed to be an organ that predicted the future and housed the soul.
Greece and Rome: Hippocrates (4-3rd century BC), who said that the liver provided the necessary nutrients for the soul, first wrote that liver trauma was a serious event
Middle Ages: Liver surgery could not make great progress because medical knowledge was limited.
Modern Period
Francis Glisson was the first physician to correctly describe the basic anatomy of the liver and its vessels. The first recorded partial hepatectomy was performed by Berta in 1716, by amputating the injured liver tissue protruding from a stab wound. In the second half of the 1800s, gastrectomy and cholecystectomy were performed in Europe, but liver surgery was still considered impossible. In 1870, Von Burns performed a left hepatectomy via laparotomy on a soldier wounded in the Prussian-French War. In 1888, Langenbuch performed an elective liver adenoma resection on a 30-year-old woman. In the USA, Keen wrote in 1892 that he had encountered 20 published liver resections up to that time.
Liver surgery began to become safer with the discovery of anesthesia and antiseptic methods.
First Liver Transplant: The first successful liver transplant was performed in 1963.
Laparoscopic Surgery: With the development of laparoscopic surgery in the 1980s, liver surgeries have become less invasive.
Robotic Surgery: With the development of robotic surgery in recent years, liver surgery has become more sensitive and safe.
Important Developments and Techniques
Partial Hepatectomy: Removal of a portion of the liver has been performed since the 18th century.
Hemostasis Methods: Different methods have been developed to stop bleeding in liver surgeries. Some of these are:
– Cauterization: One of the first methods used.
– Liver Suture: Stitching the liver tissues with blunt-tipped needles.
– Pringle Maneuver: Temporarily stopping blood flow in the liver and controlling bleeding, first described by Hogarth Pringle in 1902.
– Finger Fracture: The method of exposing the veins by crushing the liver tissue with a finger was proposed by Anschutz in 1903 and Lin popularized it.
Segmental Anatomy: Thanks to the segmental anatomy that Couinaud introduced in the 50s, liver surgery has become more applicable.
Today
Today, liver surgery is used in the treatment of many diseases such as liver cancer, metastatic tumors, benign tumors, cirrhosis and cysts. With the developments in imaging such as computerized tomography and magnetic resonance, indocyanine green clearance test, intraoperative USG, CUSA used for liver transection, local ablative devices such as stapler, radiofrequency, bipolar advanced electrocauteries such as aqumantis and the use of local hemostatic agents, liver surgery is performed safely by HPB surgeons.
In summary, liver surgery has a history of thousands of years and has come a long way with the development of medicine. Today, liver patients are offered a better quality of life with minimally invasive techniques, advanced imaging methods and new treatment options.
What is Liver Cancer?
Liver cancer is a serious disease that occurs when liver cells multiply uncontrollably and form tumors. This disrupts the normal functions of the liver and leads to various health problems.
Types of Liver Cancer
There are two main types of liver cancer:
Primary Liver Cancer: A type of cancer that starts in the liver itself. The most common type is hepatocellular carcinoma (HCC).
Secondary Liver Cancer: It consists of cancer cells that spread (metastasize) to the liver from a cancer in another part of the body.
MALIGNANT TUMORS OF THE LIVER
I- Primary malignant tumors:
- Primary epithelial carcinoma
- Hepatocellular carcinoma: HCC: most common primary.
- Cholangiocarcinoma
- Hepatoblastoma: Most common in childhood
- Mesenchymal tumors
- mixed tumor, rhabdomyosarcoma, angiosarcoma, sarcoma
II-Metastatic malignant tumors:
Liver metastases are the most common malignant tumors of the liver.
Causes of Liver Cancer
Liver cancer can occur for various reasons. The most common of these are:
Chronic hepatitis B and C: These viruses cause long-term damage to the liver, paving the way for cancer.
Alcohol use: Excessive alcohol consumption increases the risk of liver cirrhosis and subsequently liver cancer.
Cirrhosis: It is the condition in which the liver tissue hardens and loses its function.
Fatty liver disease: Fat accumulation in the liver can lead to liver cancer.
Aflatoxin: This poisonous substance found in some foodstuffs can cause liver cancer.
Smoking: Increases most cancers
Genetic Metabolic diseases: Hemochromatosis, a1 antitrypsin deficiency, Wilson’s disease, such disorders may increase the risk of liver cancer)
Liver Cancer Symptoms
Liver cancer may not show any symptoms at the beginning. However, as the disease progresses, the following symptoms may be seen:
*Abdominal pain
*Loss of appetite and weight loss
*Jaundice
*Weakness and fatigue
*Fever
*Abdominal swelling
The most common symptoms are weight loss and weakness, which are found in 80% of patients. Pain in the epigastrium or right upper abdomen is present in half of the patients (75% in fibrolamellar ca). Intraperitoneal hemorrhage, which is seen in 10% of patients due to erosion of necrotic nodules or blood vessels, may also cause acute abdominal findings. Ascites develops in 50-75%. Budd-Chiari may present with jaundice, hemobilia and fever. Paraneoplastic syndrome (hypocalcemia, hypoglycemia, erythrocytosis) is rare.
Liver Cancer Diagnosis
Liver cancer may not cause any complaints at first. Some risky patients (with chronic viral hepatitis, cirrhosis, etc.) should be monitored. The patient’s complaint, examination findings, medical history, laboratory and imaging methods are used to make a diagnosis:
Blood tests: Liver enzymes and function tests, measurement of AFP tumor markers
Ultrasound: This is the first choice for imaging the liver.
Computed tomography (CT): It provides more detailed imaging of the liver, and is the most commonly used method for both tumor diagnosis and surgical planning.
Magnetic resonance imaging (MR): It provides imaging of the liver from different angles, characterization of lesions, and provides additional findings to CT, especially in cirrhotic and fatty liver.
PET-CT: Especially in metastatic cancers and locally advanced cancers, other foci can be revealed with a single film.
Biopsy: A biopsy is not taken in lesions that will require surgery; however, in cases that are not suitable for surgery or are very complex, a tissue sample is taken from the liver with a fine needle or a thick cutting needle to be examined under a microscope.
Liver Cancer Treatment
Liver cancer treatment is determined by the patient’s general condition, tumor size, location and spread. Treatment options include surgery, chemotherapy, radiotherapy, targeted therapy, TACE, TARE and ablation treatments.
Liver cancer is a serious disease and early diagnosis and treatment can significantly extend life expectancy. Therefore, regular health check-ups and avoiding risk factors are very important.
What are Liver Cancer Treatment Options?
1-Hepatic resection
- Right-Left hepatectomy
- Right-Left extended hepatectomy
- Segmentectomy
- Metastasectomy
2-Liver transplantation
3-Ablation techniques
- Radiofrequency ablation
- Ethanol ablation
- Cryoablation
- Microwave ablation
4-Regional liver treatments
- Chemoembolization/embolization: TACE
- Hepatic artery pump chemoperfusion IACT
- Yttrium-90 treatment: TARE
5-Radiotherapy: beam radiation therapy
- Stereotactic radiosurgery (CyberKnife, Trilogy, Synergy)
- Intensity modulated radiation therapy
6.Systemic chemotherapy
7.Multiple combined treatment approaches
Liver Tumors, Hepatic resection: Both benign and malignant tumors is the surgical removal process.
Liver Transplantation in HCC (Liver Tx): In hepatocellular liver cancers, if the tumor is in a location that cannot be removed technically or if the liver cirrhosis is too severe to tolerate surgery, liver transplantation can be performed on the cancer patient by observing some criteria such as Milan Criteria.
Milan Criteria in Liver Transplantation: 1. Single Tm ≤5cm, or 2. Multiple Tm ≤3 and ≤3cm 3. If there is no extrahepatic involvement, the liver will benefit from tx.
How is Liver Cancer Treated, Is Surgery the Most Important Weapon?
Whether it is primary liver cancer or metastasis, the best result is achieved with surgery. However, since HCC also has underlying cirrhosis, the severity of cirrhosis also affects the decision to operate. 60% of HCC patients die from cancer and 40% from underlying cirrhosis. If the tumor is small, in a suitable location and can be easily removed with surgery, but the cirrhosis is severe, then we recommend a liver transplant rather than removing the tumor. If the cirrhosis is new and mild, then the tumorous part of the liver is removed with surgery. Curative treatment is surgery and provides the best long-term survival, i.e. life.
Only 5-20% of those with primary liver carcinoma are suitable for surgical resection, 20-40% of the old and new series. The surgical mortality is between 3-20% (5% in good centers). Survival after curative surgery in HCC is 1 year: 58-100%, 3 years: 28-88%, 5 years: 11-75% and 10 years 19-26%
The best result in metastasis is always surgery. However, metastases are usually not single. In the past, colorectal cancer metastases in the liver were called stage 4 and were not operated on and were only followed with KT. 5-year survival was 3%. Later, surgery began to be performed, but surgery was considered for metastases that affected one side of the liver, were not more than 4 in number or smaller than 5 cm, and if there was no tumor outside the liver, today there have been radical changes. The size and number of metastases are no longer important, if every metastasis can be removed during surgery and the ones that cannot be removed can be burned with the method we call RF ablation, and if the remaining liver is sufficient for the patient (25-30% of the total liver volume, 40% in patients who have received chemotherapy), we definitely perform surgery. In the past, CRC metastases could be operated on at 20%, but now this rate has been doubled. In fact, if there is a recurrence after metastasis surgery, liver metastasis surgery can be performed a second time at 20%. Of course, tumorous areas detected outside the liver should also be removed. Sometimes, one lobe of the liver can be removed and the metastases on the other side can be burned, or if the remaining liver is not sufficient, the vein on the tumorous side of the liver is angiographically blocked with the method we call portal vein embolization, and the remaining liver is waited to grow in 2-6 weeks and then surgery is performed.
Why Are Liver Surgeries Feared? Is It Difficult?
After the anatomy of the liver was well understood, the first surgery to remove the right lobe of the liver was performed by the German Wendell in 1911, and similar surgeries began to become widespread in the 50s (Japanese Honjo 1950, French Lortat-Jacob 1952, British Quattlebaum 1953, etc.). Blumgart from the USA, one of the doyens of liver surgery, popularized this surgery in the 70s, but one in four patients died after liver surgeries, meaning there was a 25% mortality rate. The main problem was bleeding, because the anatomy of the liver is difficult and its blood supply is very high. After the 80s, the results changed with the establishment of liver, pancreas and biliary (HPB) surgery centers and the specialization of surgeons in this field. With the support of specific liver surgeons and technological devices, by the 2000s, mortality rates in major liver surgery could be reduced to 5%.
Today, in HPB surgical centers, if the patient does not have cirrhosis, the mortality rate after liver surgery is 0-2%. Therefore, patients who will undergo major liver surgery should consult HPB surgeons who are specialized in this field, which will minimize both possible postoperative complications and the risk of death.
Are There Other Promising Methods Apart from Surgery?
Surgery should be attempted by all means, but if the liver volume left in the patient after surgery is not sufficient or if surgery is technically not possible, chemotherapy can be performed first, or even a catheter can be placed in the liver vein and high-dose chemotherapy drugs can be administered directly to the liver itself. With these methods, 30% of patients who are considered unsuitable for surgery can be operated on.
Chemotherapy drugs can be administered directly to the tumor with special oily drugs, which is called transarterial chemoembolization (TAKE). If some cases are not suitable for this, radioactive microspheres that the tumor cells will hold onto are administered from the artery (TARE) and these are expected to kill the tumor cells.
In addition, with the method called RF ablation, tumors smaller than 3 cm can be burned by entering the tumor with a needle. The RF burning method is also used in surgery. It increases the chance of surgery from 20% to 40%.
If the remaining liver volume may be insufficient at the beginning, the vessels of the tumorous half of the liver are angiographically blocked with Portal vein embolization (PVE) and the other side liver half may grow and provide an opportunity for surgery. The same procedure can also be provided with the surgical procedure called ALPPS (Liver splitting and portal vein ligation for staged hepatectomy).
Liver surgery combines advanced technologies and precise planning in detail. Especially in disease disease, the surgical plan is made by considering the general health status of the person, the stage of the disease and the condition of the healthy areas of the disease.
Prof. Dr. Kemal DOLAY, an expert in this field, is one of the prominent names in terms of both technical knowledge and experience in liver diseases. By offering individualized treatment options to patients, he increases surgical success rates and tries to minimize the risks of complex surgery.
What does liver metastasis (metastatic liver tumor) mean?
The spread of cancer from one place (organ) to another organ in the body means that the cancer has metastasized. Intra-abdominal cancers most often spread to the liver after the lymph nodes, and the most common malignant tumors of the liver are these metastatic, that is, cancers that come from other organs.
Is it possible to treat liver metastases?
The treatment of liver metastases depends on where the spread is (which organ’s cancer belongs to), the extent of the event (how many metastases are there in the liver), the location of the metastases in the liver, and whether there is spread anywhere else besides the liver. Lymphomas in particular can be treated with some chemotherapy combinations. Breast and lung cancers partially benefit from chemotherapy.
In terms of the treatment of liver metastases, it is necessary to keep colon (colorectal) cancer metastases separate. Colorectal cancers often metastasize to the liver, and surgical removal of metastases in these cancers is very important for treatment.
Risks During Liver Surgery
Bleeding: Liver tissue is fragile and the risk of bleeding due to the extensive vascular network of the liver is high.
Bile Leakage: Bile leakage may occur in case of damage to the bile ducts or due to bile anastomoses.
Infection: The risk of infection after surgery is minimized with surgical equipment, asepsis-antisepsis rules and appropriate antibiotic prophylaxis.
Liver Failure: This risk may occur especially in cases where the remaining liver tissue is not sufficient.
Factors That Make Surgery Safer
Experienced Surgeon: Liver surgery requires serious knowledge and experience. In this field, Prof. Dr. Kemal DOLAY is a prominent name with his superior surgical skills and mastery of modern techniques.
Advanced Technological Methods: Special devices used in liver dissection and transection, use of hemorrhage-stopping instruments and materials, and use of laparoscopic or robotic surgery in appropriate cases can reduce the risk of complications.
Preoperative Preparation of the Patient: Nutritional and infectious status, Diet, drug therapy and correct diagnosis, and correct treatment decision are reflected positively in all results.
How Many Hours Does Liver Cancer Surgery Take?
The duration of liver cancer surgery varies depending on many factors such as the size and location of the cancer and the type of surgery. These surgeries last between 3 and 7 hours.
Factors Affecting the Recovery Process After Surgery
The best recovery results are achieved with a correct diagnosis, the right surgical option, an experienced hospital and a multidisciplinary approach, a good surgical technique.
The Difference with Prof. Dr. Kemal DOLAY’s Experience
Prof. Dr. Kemal DOLAY, an expert in cancer surgery, has significant experience in optimizing surgery times and minimizing complication risks. Thanks to his mastery of modern surgical techniques and disease-specific treatment plans, he both increases surgical success and accelerates recovery processes.
The Role of Prof. Dr. Kemal DOLAY in Cancer Diseases and Cancer Surgery
Cancer surgery plays a critical role in both the diagnosis and treatment processes. In this process, the surgeon’s expertise, experience and mastery of modern surgical techniques directly affect the patient’s results. Prof. Dr. Kemal DOLAY is a prominent name with his success, comprehensive approaches and multidisciplinary treatment in cancer surgery.
Prof. Dr. Kemal DOLAY’s Prominent Features in Cancer Surgery
Surgical Experience and Expertise
Prof. Dr. Kemal DOLAY makes a difference with his long years of experience in HPB cancers and other complex cancer types.
He also draws attention with his high success rates in bile duct and pancreas surgery, even in the most complex cases.
Patient-Specific Treatment Planning
In cancer patients, Prof. Dr. Kemal DOLAY creates a surgical plan specific to the cancer patient by using detailed evaluation and advanced imaging methods and by including the patients in the process.
He offers the best treatment options in cooperation with radiologists, oncologists and other areas of expertise with a multidisciplinary approach in the pre-operative process.
Modern and Innovative Surgical Techniques
Prof. Dr. Kemal DOLAY also performs advanced technological procedures such as minimally invasive surgery (laparoscopic surgery and robotic surgery) and Flexible Endoscopy, ERCP with competence.
These techniques reduce post-operative complications, accelerate the recovery process and increase the quality of life of patients.
Success in Complex Cases
Prof. Dr. Kemal DOLAY is quite successful in complex and high-risk cases such as vascular resection and multiple organ resection in locally advanced cancers, tumors involving vessels or tumors affecting surrounding organs.
Impact on Patients
High Post-Operative Success Rate: The surgeries performed by Prof. Dr. Kemal DOLAY attract attention with their high success rates. The low post-operative complication rates allow patients to recover faster and safer.
Strong Competence in Patient Communication: Prof. Dr. Kemal DOLAY establishes open and transparent communication with patients and their families at every stage of the surgical process and includes them in decisions.
Active Role in Every Stage of Treatment: Supports patients not only during surgical interventions but also during preoperative evaluation and postoperative follow-up processes.
What are the 5 Symptoms of Liver Failure or Improperly Functioning Liver?
Yellowing of the Skin and Eyes (Jaundice): If the liver’s bilirubin metabolism is impaired or if it cannot be excreted into the intestines, this substance accumulates in the blood. As a result, the skin and whites of the eyes take on a yellow color.
Fatigue and Weakness: When the liver is impaired, the excretion of harmful substances from the body slows down, and the killing of microbes absorbed from the intestines in the liver decreases. This negatively affects energy production and general health, and causes the person to feel constantly tired and weak.
Abdominal Swelling (Ascites): The accumulation of fluid in the abdomen due to liver diseases is called ascites. This condition is usually a symptom of chronic diseases such as cirrhosis. It can cause complaints such as swelling, discomfort and difficulty breathing in the abdominal area.
Itching and Rashes on the Skin: When the liver does not function normally, bile salts accumulate in the body. This accumulation can cause intense itching on the skin.
Color and Stool Color Changes: When bile cannot flow into the intestines, the skin may be yellow and the stool may be light or clay-colored.
Does fatty liver also cause liver cancer?
Fatty liver is a disease that occurs due to the accumulation of excess fat in liver cells and is a condition that is increasing in Turkey and the world. If precautions are not taken or treated for fatty liver, it can cause cirrhosis and liver cancer. Losing weight, doing regular exercise, staying away from animal fats and processed sugary foods or switching to the Mediterranean diet are good for fatty liver.
What should we do to prevent fatty liver?
▪︎It is possible to prevent fatty liver with some precautions.
▪︎It is necessary to consume plenty of fresh vegetables in season and 1 serving of fruit per day, and to stay away from processed, packaged foods and fast-food meals.
▪︎Stay away from carbohydrates such as bread, potatoes, rice, pasta, pastries and sweets.
▪︎In addition, daily exercise, maintaining your ideal weight or losing at least 10% weight if you are obese, and avoiding alcohol are among the main measures to prevent fatty liver.
Fatty Liver and Weight Loss
Fatty liver can also develop in people who do not drink alcohol and it is a condition that can seriously affect our health.
Studies show that losing weight can reduce fatty liver and it has been shown that fatty liver decreases with a 10% weight loss in 6 months.
How Should You Eat to Protect Yourself from Liver Cancer?
The liver has many vital functions such as storing vitamins and minerals, producing blood clotting factors, synthesizing enzymes and proteins, storing fat and sugar, and removing alcohol, drugs and toxic substances from the body.
Avoiding alcohol, smoking and unnecessary drug use, doing regular exercise, staying away from stress, having regular health checks and eating healthy are the most important of these. In particular, implementing an unhealthy diet plan causes the liver to become tired and fatty, damaging the organ.
Therefore, implementing a diet that is balanced in protein, fat and carbohydrates and contains sufficient amounts of fresh fruits and vegetables is essential for protecting liver health. In addition, some natural food types help maintain liver health and contribute to the prevention of liver diseases.
What is Liver Cirrhosis?
Liver cirrhosis is a chronic disease that develops due to hepatitis virus, chronic alcohol and steatosis and causes irreversible damage to the liver.
The liver is an organ that performs important functions in the body. These include digestion, filtering the blood, elimination of drug metabolites and toxins, and synthesis of useful proteins.
Liver cirrhosis can cause these functions to deteriorate and cause various health problems such as esophageal varices, bleeding, jaundice, etc.
The Most Common Causes of Liver Cirrhosis
- Alcoholism
- Hepatitis B and C
- Autoimmune liver disease
- Cancer
- Genetic factors
Symptoms of Liver Cirrhosis
There are usually no signs or symptoms in the early stages of liver cirrhosis. As the disease progresses, the following symptoms may occur:
- Fatigue
- Loss of appetite
- Weight loss
- Abdominal pain
- Abdominal fluid accumulation
- Yellowing of the skin and eyes
- Bleeding and clotting problems
- Abdominal fluid accumulation
Blood tests, imaging tests, and liver biopsy may be used to diagnose liver cirrhosis.
Treatment of liver cirrhosis depends on the underlying cause. In liver cirrhosis caused by alcoholism, it is important to stop drinking alcohol. In liver cirrhosis caused by hepatitis B and C, antiviral medications may be used. In people with autoimmune liver disease, medications that suppress the immune system may be used. In people who develop liver cirrhosis due to cancer, surgery or radiation therapy may be required.
Liver cirrhosis is a life-threatening disease. Early diagnosis and treatment are important to slow the progression of the disease and prevent complications.
HYDATIC CYST
What is Liver Hydatid Cyst?
Hydatid cyst disease is a disease caused by a parasite called Echinococcus, which particularly affects the liver. It is also known among the public as “dog cyst”. This parasite spreads through the feces of dogs and other carnivorous animals and can infect people. Its main feature is the formation of cysts in the body.
Cysts in the liver usually form in the right lobe of the liver. Cysts can also be seen in other organs other than the liver. Cysts are usually fluid-filled sacs and do not often cause complaints, but especially those larger than 10 cm can cause various complaints and complications. The most common complaint is abdominal pain.
Intrahepatic (inside the liver) complications include the effect of the blood vessels and bile ducts due to the growth of the cyst. The growing cyst can put pressure on the surrounding tissues and cause atrophic changes. The most common and serious complication is the rupture of the cystic bile ducts.
Extrahepatic (outside the liver) complications occur when the cyst spreads to other organs outside the liver. This spread occurs when the cyst grows outward and reaches other organs through the bloodstream. It may spread to the lungs, mediastinum (middle space), heart, and peritoneum (abdominal membrane).
The disease is usually diagnosed with imaging tests (often ultrasound) and blood tests. No biopsy is required. Treatment includes percutaneous drainage with medication and usually surgery (open or closed surgery), although medical treatment may also be considered in high-risk cysts. Therefore, it is important for people with suspected liver hydatid cysts to consult with their specialist physicians and receive information about appropriate treatment options.
What Kind of Complaints Does Liver Hydatid Cyst Cause?
Liver hydatid cysts often do not cause any complaints or cause mild discomfort.
Complaints become apparent after the cyst diameter reaches 10 cm.
The most common complaints are abdominal pain in the right upper quadrant or epigastrium, and the most common findings on examination are liver enlargement and a palpable mass.
In addition, a feeling of abdominal fullness, nausea and vomiting may also be seen.
Is Liver Hydatid Cyst Contagious?
The disease occurs through close contact with animals carrying these parasites and oral ingestion of substances (food, water, grass, etc.) contaminated with parasite eggs under poor hygiene conditions.
Liver hydatid cysts are not transmitted from person to person. They are not found in human feces.
However, contaminated foods somehow contaminated with parasite eggs can be ingested by everyone, and therefore the disease can occur in different members of the family.
Can Liver Hydatid Cysts Be Treated with Medication?
In small and early-stage cysts, complete healing can be attempted with medication.
Drug treatment is usually applied for 1-3 months as an adjunct to surgery or radiological treatments.
The gold standard for definitive treatment is still surgery.
Does Liver Hydatid Cyst Explode on Its Own?
One third of liver hydatid cysts cause complications, that is, problems that can lead to death if left untreated.
The most common complication is what we call explosion or rupture. This rupture most often occurs in the bile ducts within the liver and leads to fatal emergencies such as inflammatory jaundice (cholangitis) and/or pancreatitis (acute pancreatitis).
In addition, hydatid cysts can rarely rupture into the abdomen or lung cavity, causing very serious conditions.
How does hydatid cyst disease occur?
Close contact with animals carrying these parasites and ingestion of substances contaminated with parasite eggs (food, water, grass, etc.) under poor hygiene conditions cause the eggs to hatch in the intestines of humans and the parasites that come out of them usually settle in the liver, causing a “Liver Hydatid Cyst”.