Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12439-12447
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12439
Combined transjugular intrahepatic portosystemic shunt and other interventions for hepatocellular carcinoma with portal hypertension
Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Jian-Nan Yao, Fu-Quan Liu
Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Jian-Nan Yao, Chaoyang Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Qiu B and Zhao MF contributed equally to this work; Qiu B, Zhao MF and Liu FQ designed the research; Liu FQ supervised the study; Qiu B, Zhao MF, Yue ZD, Zhao HW, Wang L and Fan ZH performed the research; He FL, Dai S and Yao JN analyzed the data; and Qiu B wrote the paper.
Institutional review board statement: The study was reviewed and approved by Institutional Review Board at Beijing Shijitan Hospital. All procedures were conducted according to the guidelines of the Ethics Committee at Beijing Shijitan Hospital.
Informed consent statement: Informed consent was acquired from each participate or their legal guardian before the operation.
Conflict-of-interest statement: The authors declared that there are no conflicts of interest in this study.
Data sharing statement: No additional data are available.
Open-Access: 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/
Correspondence to: Fu-Quan Liu, Professor, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Rd., Yangfangdian, Haidian District, Beijing 100038, China. anglebin@126.com
Telephone: +86-10-63926272 Fax: +86-405-2711766
Received: May 30, 2015
Peer-review started: June 5, 2015
First decision: July 19, 2015
Revised: August 5, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: November 21, 2015
Processing time: 171 Days and 15.1 Hours
Abstract

AIM: To evaluate combination transjugular intrahepatic portosystemic shunt (TIPS) and other interventions for hepatocellular carcinoma (HCC) and portal hypertension.

METHODS: Two hundred and sixty-one patients with HCC and portal hypertension underwent TIPS combined with other interventional treatments (transarterial chemoembolization/transarterial embolization, radiofrequency ablation, hepatic arterio-portal fistulas embolization, and splenic artery embolization) from January 1997 to January 2010 at Beijing Shijitan Hospital. Two hundred and nine patients (121 male and 88 female, aged 25-69 years, mean 48.3 ± 12.5 years) with complete clinical data were recruited. We evaluated the safety of the procedure (procedure-related death and serious complications), change of portal vein pressure before and after TIPS, symptom relief [e.g., ascites, hydrothorax, esophageal gastric-fundus variceal bleeding (EGVB)], cumulative rates of survival, and distributary channel restenosis. The characteristics of the patients surviving ≥ 5 and < 5 years were also analyzed.

RESULTS: The portosystemic pressure was decreased from 29.0 ± 4.1 mmHg before TIPS to 18.1 ± 2.9 mmHg after TIPS (t = 69.32, P < 0.05). Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated. During the 5 year follow-up, the total recurrence rate of resistant ascites or hydrothorax was 7.2% (15/209); 36.8% (77/209) for EGVB; and 39.2% (82/209) for hepatic encephalopathy. The cumulative rates of distributary channel restenosis at 1, 2, 3, 4, and 5 years were 17.2% (36/209), 29.7% (62/209), 36.8% (77/209), 45.5% (95/209) and 58.4% (122/209), respectively. No procedure-related deaths and serious complications (e.g., abdominal bleeding, hepatic failure, and distant metastasis) occurred. Moreover, Child-Pugh score, portal vein tumor thrombosis, lesion diameter, hepatic arterio-portal fistulas, HCC diagnosed before or after TIPS, stent type, hepatic encephalopathy, and type of other interventional treatments were related to 5 year survival after comparing patient characteristics.

CONCLUSION: TIPS combined with other interventional treatments seems to be safe and efficacious in patients with HCC and portal hypertension.

Keywords: Transjugular intrahepatic portosystemic shunt; Interventional treatment; Hepatocellular carcinoma; Portal hypertension

Core tip: There are conflicting results about the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with other interventional treatments for patients with hepatocellular carcinoma (HCC) and portal hypertension. We reviewed 209 patients with HCC and portal hypertension who underwent TIPS and other interventional treatments. Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated, and no procedure-related deaths and serious complications occurred. The survival rates for TIPS in combination seem better than those reported for transarterial chemoembolization or radiofrequency ablation alone.