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CardioVascular and Interventional Radiology

, Volume 40, Issue 9, pp 1372–1382 | Cite as

Transjugular Intrahepatic Portosystemic Shunt for Portal Hypertension in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

  • Bin Qiu
  • Kai Li
  • Xiaoqun Dong
  • Fu-Quan Liu
Clinical Investigation
  • 364 Downloads

Abstract

Purpose

In patients with hepatocellular carcinoma (HCC), limited therapeutic options are available for portal hypertension resulted from portal vein tumor thrombus (PVTT). We aimed to determine safety and efficacy of TIPS for treatment of symptomatic portal hypertension in HCC with PVTT.

Methods

We evaluated clinical characteristics of 95 patients with HCC and PVTT out of 992 patients who underwent TIPS. The primary endpoints included success rate, procedural mortality, serious complications, decrease in portosystemic pressure gradient, and symptom relief. The secondary endpoints included recurrence of portal hypertension, overall survival, adverse events related to treatments for HCC, and quality of life measured by Karnofsky Performance Status Scale (KPS).

Results

Success rate of TIPS was 95.8% (91/95), with procedural mortality of 1.1%. Serious complications related to TIPS procedure occurred in 2.1% (2/95) of patients. The symptoms of portal hypertension were well relieved. Variceal bleeding was successfully controlled and terminated in 100% of patients, with a recurrence rate of 39.2% in 12 months. Refractory ascites/hydrothorax was controlled partially or completely in 92.9% of patients during 1 month after TIPS, with a recurrence rate of 17.9% in 12 months. Survival rate at 6, 12, 24, and 36 months was 75.8, 52.7, 26.4, and 3.3%, respectively. No unexpected adverse event related to treatments for HCC was observed. The KPS score was 49 ± 4.5 and 63 ± 4.7 before and 1 month after TIPS, respectively (p < 0.001).

Conclusions

TIPS is a safe and efficacious treatment for symptomatic portal hypertension in HCC with PVTT.

Keywords

Hepatocellular carcinoma Transjugular intrahepatic portosystemic shunt Portal vein tumor thrombus Portal hypertension 

Notes

Author’s Contributions

BQ, KL contributed equally to this work; BQ, FL designed the research; FL supervised the study; BQ, KL, XD performed the research, analyzed the data; and BQ, FL wrote the paper.

Compliance with Ethical Standards

Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Faitot F, Allard MA, Pittau G, et al. Impact of clinically evident portal hypertension on the course of hepatocellular carcinoma in patients listed for liver transplantation. Hepatology. 2015;62:179–87.CrossRefPubMedGoogle Scholar
  2. 2.
    Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet. 2014;383:1749–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Goh KL, Razlan H, Hartono JL, et al. Liver cancer in Malaysia: epidemiology and clinical presentation in a multiracial Asian population. J Dig Dis. 2015;16:152–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Takizawa D, Kakizaki S, Sohara N, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci. 2007;52:3290–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999;29:62–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38:258–66.CrossRefPubMedGoogle Scholar
  7. 7.
    Kudo M, Kitano M, Sakurai T, et al. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: The outstanding achievements of the liver cancer study group of japan. Dig Dis. 2015;33:765–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Parker R. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Clin Liver Dis. 2014;18:319–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Parvinian A, Gaba RC. Parallel TIPS for treatment of refractory ascites and hepatic hydrothorax. Dig Dis Sci. 2013;58:3052–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Gaba RC, Parvinian A, Casadaban LC, et al. Survival benefit of TIPS versus serial paracentesis in patients with refractory ascites: a single institution case-control propensity score analysis. Clin Radiol. 2015;70:e51–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Salerno F, Camma C, Enea M, et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133:825–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Burger JA, Ochs A, Wirth K, et al. The transjugular stent implantation for the treatment of malignant portal and hepatic vein obstruction in cancer patients. Ann Ocol. 1997;8:200–2.CrossRefGoogle Scholar
  14. 14.
    Chung WJ, Jang BK, Park KS, et al. Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis. Kor J Hepatol. 2005;11:157–63.Google Scholar
  15. 15.
    Jiang ZB, Shan H, Shen XY, et al. Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis. World J Gastroenterol. 2004;10:1881–4.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zhao JB, Feng C, Zhu QH, et al. Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2014;20:1602–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Liu L, Zhao Y, Qi X, et al. Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis. Hepatol Res. 2014;44:621–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Colombato L. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. J Clin Gastroenterol. 2007;41(Suppl 3):S344–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Bettinger D, Knuppel E, Euringer W, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther. 2015;41:126–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Han G, Qi X, He C, Yin Z, et al. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis. J Hepatol. 2011;54:78–88.CrossRefPubMedGoogle Scholar
  21. 21.
    Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis. Gut. 2011;60:846–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Ganger DR, Klapman JB, McDonald V, et al. Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: Review of indications and problems. Am J Gastroenterol. 1999;94:603–8.PubMedGoogle Scholar
  23. 23.
    Dhanasekaran R, West JK, Gonzales PC, et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol. 2010;105:635–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Wallace MJ, Madoff DC, Ahrar K, et al. Transjugular intrahepatic portosystemic shunts: experience in the oncology setting. Cancer Am Cancer Soc. 2004;101:337–45.Google Scholar
  25. 25.
    Chung WJ, Jang BK, Park KS. et al [Effect of transjugular intrahepatic portosystemic shunt for variceal bleeding in hepatocellular carcinoma patients with portal vein thrombosis]. Korean J Hepatol. 2005;11:157–63.PubMedGoogle Scholar
  26. 26.
    Lee HS, Kim JS, Choi IJ, et al. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction: a prospective controlled study. Cancer Am Cancer Soc. 1997;79:2087–94.Google Scholar
  27. 27.
    Asahara S, Ikari T, Kamei A, et al. A case of diffuse type of hepatocellular carcinoma with tumor thrombosis of inferior vena cava (Vv3) and main trunk of portal vein (Vp4), showing marked response to transcatheter arterial chemoembolization with degradable starch microspheres (DSM-TACE). Nihon Shokakibyo Gakkai Zasshi. 2004;101:1332–9.PubMedGoogle Scholar
  28. 28.
    Sakaguchi H, Uchida H, Maeda M, et al. Combined transjugular intrahepatic portosystemic shunt and segmental Lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: Preliminary report. Cardiovasc Intervent Radiol. 1995;18:9–15.CrossRefPubMedGoogle Scholar
  29. 29.
    Kuo YC, Kohi MP, Naeger DM, et al. Efficacy of TACE in TIPS patients: comparison of treatment response to chemoembolization for hepatocellular carcinoma in patients with and without a transjugular intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol. 2013;36:1336–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Qiu B, Zhao MF, Liu FQ, et al. Combined transjugular intrahepatic portosystemic shunt and other interventions for hepatocellular carcinoma with portal hypertension. World J Gastroenterol. 2015;21:12439–47.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  1. 1.Department of Interventional Therapy, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of General Surgery, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
  3. 3.Section of Gastroenterology, Section of Hematology/Oncology, Stephenson Cancer Center, Department of Internal Medicine, College of MedicineThe University of Oklahoma Health Sciences CenterOklahoma CityUSA
  4. 4.Department of Interventional Therapy, National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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