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. 2022 Jun 27;14(6):567-579.
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  1 , Zhen-Dong Yue  2 , Hong-Wei Zhao  3 , Lei Wang  2 , Zhen-Hua Fan  2 , Yi-Fan Wu  2 , Ming-Ming Meng  4 , Ke Zhang  5 , Li Jiang  5 , Hui-Guo Ding  6 , Yue-Ning Zhang  7 , Yong-Ping Yang  8 , Fu-Quan Liu  1
Affiliations

Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension

Xuan-Hui Yan et al. World J Gastrointest Surg. .

Abstract

Background: Patients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis (mPVTT) and cirrhotic portal hypertension (CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment paradigm.

Aim: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT patients with CPH.

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. Procedure-related data (success rate, relief of portal vein pressure and CPH symptoms, and adverse events), PVTT response, and patient survival were assessed through a 2-year follow-up.

Results: The success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure (22.25 ± 7.33 mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo (range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%, and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage, and PVTT response were independent prognostic factors (P < 0.05).

Conclusion: TIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.

Keywords: Cirrhosis; Cirrhotic portal hypertension; Hepatocellular carcinoma; Portal vein tumor thrombosis; Radioactive seed strand; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Assembly of a radioactive seed strand in vitro.
Figure 2
Figure 2
Representative case. A: Filling defect in the main portal vein (black arrow), suggesting main portal vein tumor thrombosis; B: Most of the intrahepatic branches did not develop under contrast, and several short gastric veins were obviously varicose; C and D: A guidewire was retained in the splenic vein, a catheter was directed into the secondary branch of the right portal vein, and then a radioactive seed strand (white arrow) was implanted; E: Another radioactive seed strand (white arrow) was implanted into another secondary branch of the right portal vein; F: A shunt of transjugular intrahepatic portosystemic shunt (black arrow) was established, a distal stent (short white arrow) was placed, and then a radioactive seed strand (long white arrow) was implanted. Portal venography showed unobstructed blood flow in the shunt and obvious reduction in the varicose veins; G: Schematic diagram. TIPS: Transjugular intrahepatic portosystemic shunt.
Figure 3
Figure 3
Kaplan-Meier survival curve for all patients.
Figure 4
Figure 4
Kaplan-Meier survival curve for different stratification factors. A: Gender group; B: Age group; C: Barcelona Clinic Liver Cancer stage; D: cTNM stage; E: Child-Pugh grade; F: Portal vein tumor thrombosis response). BCLC: Barcelona Clinic Liver Cancer; PVTT: Portal vein tumor thrombosis.
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