Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma

Abstract

BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement, and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups ( P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups ( P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A ( P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ 2 = 12.227, P = 0.018; χ 2 = 12.457, P = 0.014; χ 2 = 26.490, P = 0.013; χ 2 = 21.956, P = 0.009, and χ 2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Group B. Mean and median survival differed significantly between the two groups ( P = 0.000, χ 2 = 35.605, log-rank test). The mortality rate from VB in Group A was low than that in Group B ( P = 0.006), but the rates of hepatic tumor, hepatic failure, and multiorgan failure did not differ significantly between the two groups ( P = 0.173, 0.246 and 0.257, respectively). CONCLUSION TIPS combined with palliative treatment is saf...

Feasibility and clinical value of TIPS combined with subsequent antitumor treatment in HCC patients with refractory ascites

“…Furthermore, the incidence of HE was 13.2%. This result is similar to previous research, which indicated that TIPS for HCC patients was able to obtain an acceptable HE [ [26] , [27] , [28] , [29] , [30] ]. Finally, the primary patency rates at 30 and 90 days were 95.6% and 89.7%, respectively.…”

“…Currently, few studies have reported on the feasibility and efficacy of TIPS in HCC patients [ 23 , [26] , [27] , [28] ], and this study further demonstrated the feasibility and effectiveness of TIPS in HCC patients with RA. First, a technical success of up to 100% was achieved in this study.…”

Effect of transjugular intrahepatic portosystemic shunt on transarterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis

“…1. A total of 411 articles were initially identified, of which 27 were eligible for full-text review, and 6 matched our standards (11,(17)(18)(19)(20)(21). Overall, 536 patients with HCC were included in the studies.…”

“…The main characteristics of the studies are provided in the Table . As shown, two studies were performed in China, three in the United States of America, and one in Korea. Two studies included patients who received TIPS procedure before or after TACE (17,20). In the remaining four studies, all patients received TIPS before TACE.…”

Transjugular Intrahepatic Portosystemic Shunts in High-Risk Patients

“…Despite these concerns, recent studies have demonstrated technical success rates of up to 97%, with no significant increase in procedural complications. [73][74][75] Tumor rupture has been reported at 8.6% in a study by Liu et al, 76 and has been postulated to be associated with a larger tumor burden. Despite concern, there is no clear data demonstrating an increased risk of tumor tract seeding or embolic metastasis caused by TIPS placement.…”