Wu ZQ, Wang F, Wang FP, Cai HJ, Chen S, Yang JY, Guo WB. Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus. World J Gastrointest Surg 2024; 16(9): 2778-2786 [DOI: 10.4240/wjgs.v16.i9.2778]
Corresponding Author of This Article
Wen-Bo Guo, PhD, Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshaner Road, Guangzhou 510080, Guangdong Province, China. guowenbo@mail.sysu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Sep 27, 2024; 16(9): 2778-2786 Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2778
Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus
Zhi-Qiang Wu, Fan Wang, Feng-Pin Wang, Hong-Jie Cai, Song Chen, Jian-Yong Yang, Wen-Bo Guo
Zhi-Qiang Wu, Fan Wang, Hong-Jie Cai, Song Chen, Jian-Yong Yang, Wen-Bo Guo, Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Feng-Pin Wang, Department of Medical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510080, Guangdong Province, China
Author contributions: Wu ZQ and Wang F contributed equally to this work. Wu ZQ, Wang F, and Guo WB were involved in the study design, data collection, analysis and interpretation of data, data quality control and validation and study supervision; Wu ZQ and Wang F were involved in the drafting of the manuscript; Wang FP, Cai HJ, Chen S, and Yang JY were involved in the data quality control and validation, critical revision of the manuscript for important intellectual content.
Institutional review board statement: The study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University (Approval No: [2022]120).
Informed consent statement: The requirement for informed consent was waived by the committee due to the retrospective study nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bo Guo, PhD, Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshaner Road, Guangzhou 510080, Guangdong Province, China. guowenbo@mail.sysu.edu.cn
Received: March 6, 2024 Revised: May 30, 2024 Accepted: August 1, 2024 Published online: September 27, 2024 Processing time: 196 Days and 0.5 Hours
Abstract
BACKGROUND
Whether hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and acute esophagogastric variceal bleeding (EGVB) can improve the success rate of endoscopic hemostasis and overall survival (OS) from transjugular intrahepatic portosystemic shunt (TIPS) remains controversial.
AIM
To compare the clinical outcomes between TIPS and standard treatment for such HCC patients.
METHODS
This monocenter, retrospective cohort study included patients diagnosed as HCC with PVTT and upper gastrointestinal bleeding. Patients were grouped by the treatment (TIPS or standard conservative treatment). The success rate of endoscopic hemostasis, OS, rebleeding rates, and main causes of death were analyzed.
RESULTS
Between July 2015 and September 2021, a total of 77 patients (29 with TIPS and 48 with standard treatment) were included. The success rate of endoscopic hemostasis was 96.6% in the TIPS group and 95.8% in the standard treatment group. All the 29 patients in TIPS group successful underwent TIPS procedure and had a better OS compared with standard treatment within the first 160 days after treatment (68 days vs 43 days, P = 0.022), but shorter OS after 160 days (298 days vs 472 days, P = 0.022). Cheng’s Classification of PVTT, total bilirubin and Child-Pugh class were independently negative associated with OS (all P < 0.05). The main causes of death were liver failure or hepatic encephalopathy (75.9%) in the TIPS group and rebleeding (68.8%) in the standard treatment.
CONCLUSION
TIPS could reduce the risk of early death due to rebleeding and prolong short-term survival in HCC patients with PVTT and acute EGVB, which deserves further investigation.
Core Tip: This study compared the clinical outcomes between transjugular intrahepatic portosystemic shunt (TIPS) treatment and standard conservative treatment in hepatocellular carcinoma patients with portal vein tumor thrombus and acute esophagogastric variceal bleeding. And showed that TIPS could reduce the risk of rebleeding by decreasing portal pressure, leading to prolonged short-term survival in hepatocellular carcinoma patients with portal vein tumor thrombus and acute esophagogastric variceal bleeding compared with standard conservative treatment. The safety of TIPS was also acceptable.
