Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

Xuan-Hui Yan; Zhen-Dong Yue; Hong-Wei Zhao; Lei Wang; Zhen-Hua Fan; Yi-Fan Wu; Ming-Ming Meng; Ke Zhang; Li Jiang; Hui-Guo Ding; Yue-Ning Zhang; Yong-Ping Yang; Fu-Quan Liu

doi:10.4240/wjgs.v14.i6.567

Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

World J Gastrointest Surg. 2022 Jun 27;14(6):567-579. doi: 10.4240/wjgs.v14.i6.567.

Authors

Xuan-Hui Yan¹, Zhen-Dong Yue², Hong-Wei Zhao³, Lei Wang², Zhen-Hua Fan², Yi-Fan Wu², Ming-Ming Meng⁴, Ke Zhang⁵, Li Jiang⁵, Hui-Guo Ding⁶, Yue-Ning Zhang⁷, Yong-Ping Yang⁸, Fu-Quan Liu¹

Affiliations

¹ Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Beijing 100038, China.
² Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
³ Department of Interventional Therapy, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China.
⁴ Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
⁵ Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China.
⁶ Department of Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China.
⁷ Department of Liver Disease Digestion Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China.
⁸ Department of Liver Disease, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.

Abstract

Background: Patients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis (mPVTT) and cirrhotic portal hypertension (CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment paradigm.

Aim: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT patients with CPH.

Methods: The clinical data of 83 consecutive patients who underwent TIPS combined with ¹²⁵I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data (success rate, relief of portal vein pressure and CPH symptoms, and adverse events), PVTT response, and patient survival were assessed through a 2-year follow-up.

Results: The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure (22.25 ± 7.33 mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo (range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%, and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage, and PVTT response were independent prognostic factors (P < 0.05).

Conclusion: TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.

Keywords: Cirrhosis; Cirrhotic portal hypertension; Hepatocellular carcinoma; Portal vein tumor thrombosis; Radioactive seed strand; Transjugular intrahepatic portosystemic shunt.