Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2022; 14(6): 567-579
Published online Jun 27, 2022. 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
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
Xuan-Hui Yan, Fu-Quan Liu, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Beijing 100038, China
Zhen-Dong Yue, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Hong-Wei Zhao, Department of Interventional Therapy, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
Ming-Ming Meng, Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Ke Zhang, Li Jiang, Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
Hui-Guo Ding, Department of Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
Yue-Ning Zhang, Department of Liver Disease Digestion Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
Yong-Ping Yang, Department of Liver Disease, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
Author contributions: Liu FQ designed the research; Yue ZD, Zhao HW, Wang L, Fan ZH, Wu YF, Meng MM, Zhang K, Jiang L, Ding HG, Zhang YN and Yang YP performed the research; Yan XH analyzed the data and wrote the paper; Liu FQ reviewed and edited the manuscript; all authors read and approved the manuscript.
Supported by Beijing Municipal Science and Technology Commission project, The Capital of The Public Health Cultivation, No. Z171100000417031; The Capital Health Research and Development of Special, Beijing Municipal Health Commission, No. 2018-1-2081; and Scientific Research Common Program of Beijing Municipal Commission of Education, No. KM201810025028 (to Liu FQ).
Institutional review board statement: The study was reviewed and approved by the Ethics Committee and Institutional Review Board of Peking University Ninth School of Clinical Medicine.
Informed consent statement: All study participants or their legal guardians signed written informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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: Fu-Quan Liu, BCPS, MD, Director, Professor, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, No. 10 Tie Yi Road, Yangfangdian, Haidian District, Beijing 100038, China. lfuquan@aliyun.com
Received: December 1, 2021
Peer-review started: December 1, 2021
First decision: April 16, 2022
Revised: April 21, 2022
Accepted: May 21, 2022
Article in press: May 21, 2022
Published online: June 27, 2022
Processing time: 207 Days and 22.6 Hours
ARTICLE HIGHLIGHTS
Research background

Main portal vein tumor thrombosis (mPVTT) is common in patients with hepatocellular carcinoma (HCC). Mostly based on cirrhosis, HCC is usually complicated with cirrhotic portal hypertension (CPH), which is often accompanied by high-mortality decompensated events such as esophagogastric variceal bleeding and refractory ascites/hydrothorax.

Research motivation

HCC patients with PVTT have a poor prognosis with median survival of only 2.7-4.0 mo. Once mPVTT is combined with cirrhotic decompensated events, it would deteriorate the disease and accelerate the death of patients. However, there is a lack of a clinical treatment paradigm for mPVTT patients with CPH.

Research objectives

This cohort study is to evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT complicated with CPH. It might contribute new perspectives into clinical treatment management.

Research 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, and the efficacy and safety were adequately evaluated by a 2-year follow-up.

Research results

There was universal improvement in CPH and apparent relief of its decompensated complications after operation. The majority of patients had at least a decrease in the extent of PVTT and the objective response rate of PVTT was 67.5%. The cumulative rate of shunt stenosis and recurrence rate of CPH were low within the first year. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5).

Research conclusions

TIPS combined with radioactive seed strand might be effective and safe in the treatment of mPVTT with CPH, which could effectively alleviate symptoms of portal hypertension and prolong patient survival time.

Research perspectives

In the management of HCC patients with PVTT or mPVTT, it is necessary to differentiate and effectively treat CPH. The treatment of mPVTT with CPH is still a clinical difficulty and requires multidisciplinary teamwork. Future studies may require randomized controlled trials to verify our results.