Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Abstract

BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) placement has emerged as an effective and minimally invasive method of treating portal hypertension and its associated complications. To the authors' knowledge there is limited documentation of its use for percutaneous shunting in patients with hepatic and extrahepatic malignancies. The current study reports the authors' experience with TIPS in the oncology setting.METHODSThirty‐eight patients with cancer underwent TIPS procedures. Nineteen patients had a history of hepatic malignancy. All medical records and imaging studies were reviewed retrospectively. The indication for TIPS, the presence of malignancy, procedural details, complications, survival, and treatment success were assessed.RESULTSPrimary technical success was accomplished in 37 of 38 patients (97%) without technical procedure‐related complications. Hepatic encephalopathy occurred in 15 of 34 patients (44%), with 3 patients requiring shunt reduction. Premature shunt occlusion (< 30 days) occurred in 3 patients (8%). Recurrent hemorrhage occurred in 1 of 19 patients (5%), and ascites and hepatic hydrothorax resolved or improved subjectively in 9 of 12 patients (75%). Shunts traversed malignancy in 9 patients, and varying degrees of portal compromise were encountered in 12 patients (32%). The overall 30‐day and 90‐day survival rates were 84% and 60%, respectively. There was a statistically significant difference in 90‐day survival rates for patients who had ascites and hepatic hydrothorax indications (27%) compared with patients who had variceal and portal gastropathy indications (84%; P = 0.0075). In addition, the 90‐day survival rate was significantly lower in patients who had primary hepatic malignancies (36%) compared with the remainder of the study population (74%; P = 0.0077), and it was significantly lower in patients who had model for end‐stage liver disease (MELD) scores ≥ 12 (P = 0.0020).CONCLUSIONSTIPS was performed safely for patients with cancer without increasing rates of procedure‐related complications. However, some patients subgroups, such at those with malignancy and ascites, primary hepatic malignancy, or MELD scores ≥ 12, had the lowest 90‐day survival rates. Cancer 2004. © 2004 American Cancer Society.

Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma

“…27 We also observed a similar rate of post-TIPSS HE with 40.0%. One of these patients developed severe grade IV HE and died of multiorgan failure.…”

“…Wallace et al reported a 30-day survival rate of 84%. 27 Our data even showed a rate of 97.5%. This high 30-day survival rate can be explained by strict selection for TIPSS implantation in our patient cohort.…”

“…Wallace et al reported a similar rate (8%) of shunt occlusion within the first 30 days. 27 Moreover, Saxon et al even observed a shunt occlusion rate of 17% within 30 days after TIPSS implantation in their cohort of 116 patients with liver cirrhosis, but without HCC. 46 Several mechanisms have been discussed that may explain this early shunt occlusion in patients with and without HCC.…”

“…After TIPSS implantation, portal vein pressure (PVP) decreased from median 26.5 (15-38) mmHg to 21 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) mmHg. Portosytemic gradient (PSG) decreased from median 20.0 (13.0-33.0) mmHg to 8.0 (2-16) mmHg (P < 0.001).…”

“…These studies showed a good efficacy of TIPSS implantation and no association with severe procedure-related complications. [26][27][28] However, these studies are characterised by rather small patient cohorts and by hepatic tumours of different entities. In addition, data to the OS are limited.…”