Preoperative trans-jugular porto-systemic shunt for oncological gastric surgery in a cirrhotic patient

Abstract

Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence of disease and mortality. In these patients, oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein patients. Thus, normalization of portal vein pressure may be a favorable determinant factor to reduce complications. We report a case of a patient with hepatitis C virus-related hepatic cirrhosis, esophageal varices, portal hypertension and gastric cancer. We demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more safely. We retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases.

Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery

“…A total of 8 original studies were identified. These included two case reports from the UK [ 5 ] and Italy [ 6 ], three case series from the USA [ 7 ], Spain [ 8 ] and France [ 9 ], and three retrospective studies from the USA [ 10 , 11 ] and Canada [ 12 ]. A retrospective study from the USA described 25 patients with cirrhosis undergoing abdominal or cardiothoracic surgeries [ 10 ].…”

“…The etiology of liver cirrhosis was alcohol in 47.6% (10/21) of patients, hepatitis C in 28.6% (6/21), a combination of alcohol and hepatitis C in 9.5% (2/21), primary biliary cirrhosis in 9.5% (2/21), and cryptogenic in 4.8% (1/21) of patients [ 5 - 9 , 11 ]. Vinet et al reported 61.1% (11/18) of patients to have a non-alcohol etiology without any further specification [ 12 ].…”

“…Vinet et al reported a mean CTP score of 7.7 (6-10) for the patients undergoing TIPS and 6.2 (5-9) for the control group [ 12 ]. All patients from each study had one or more signs of portal hypertension: ascites [ 7 - 12 ], esophageal varices [ 5 - 11 ], gastric varices [ 9 , 10 ], or gastrointestinal bleeding [ 5 - 11 ].…”

“…The time period between TIPS placement and abdominal surgery was variable and ranged from 1 week [ 8 ] to a mean of 2.9 months [ 9 ]. Although the hepatic venous pressure reduces immediately after TIPS placement, new hemodynamic equilibrium and its clinical effects take time [ 14 ].…”

Role Of Neo-Adjuvant TIPS in Child Pugh Class A And B Cirrhotic Patients Undergoing Elective Intra-Abdominal Surgery

“…In regards to preoperative TIPS before abdominal surgery, experience remains limited. To our knowledge this approach has been described in 7 prior studies [4,6,9,10,11,12,13] . The first study to describe this in 2001 included seven cirrhotic patients requiring planned extrahepatic intra-abdominal operations in which a "two-step"strategy" was applied performing TIPS in a time period ranging between 1-5 months prior to the planned procedure.…”