Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus

doi:10.4240/wjgs.v16.i9.2778

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

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.

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 10.6 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.

Keywords: Hepatocellular carcinoma; Portal vein tumor thrombus; Transjugular intrahepatic portosystemic shunts; Acute esophagogastric variceal bleeding; Standard treatment; Endoscopic treatment

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.