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. 2023 Oct;11(8):733-744.
doi: 10.1002/ueg2.12454. Epub 2023 Sep 22.

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

Blanca Norero  1   2 , Jaume Bosch  1 , Annalisa Berzigotti  1 , Susana G Rodrigues  1
Affiliations

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review

Blanca Norero et al. United European Gastroenterol J. 2023 Oct.

Abstract

Background/aims: Transjugular intrahepatic portosystemic shunts (TIPS) in patients with hepatocellular carcinoma (HCC) may improve access to curative therapies, treat portal hypertension (PH)-related complications without worsening liver function, and increase overall survival. Data on the efficacy and safety of TIPS to treat PH complications in HCC patients, as well as the HCC treatment response, were evaluated.

Methods: Studies reporting efficacy in controlling bleeding/ascites or response to HCC therapy, safety, and survival in patients with HCC and TIPS were searched systematically on PubMed and Embase. An extraction of articles using predefined data fields and quality indicators was used.

Results: We selected 19 studies and found 937 patients treated for ascites/bleeding and 177 evaluating HCC treatment response. Over half were under 5 cm and solitary lesions, and most studies included tumours with portal vein thrombosis. Regarding PH studies, TIPS resolved bleeding/ascites in >60% of patients, more effective for bleeding. There were no lethal complications reported and procedural bleeding occurred in <5%. Hepatic encephalopathy occurred in 15%-30% within three months. In the HCC treatment-response studies, major complication rates were low with no mortality. In the studies that evaluated the response to transarterial chemoembolization, complete response rate of patients with TIPS varied from 16% to 75%. Liver transplantation rate varied from 8% to 80%, with >40% rate in half of the studies.

Conclusions: In the published studies, TIPS is effective in treating PH complications in patients with HCC. Prospective studies on TIPS placement in patients with HCC are urgently needed to evaluate the efficacy and safety of TIPS in this setting.

Keywords: HCC; TIPS; cirrhosis; hepatocellular carcinoma; liver cancer; portal hypertension.

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Conflict of interest statement

Jaume Bosch disclosures: consultant to Astra‐Zeneca, BioVie, Boehringer Ingelheim, NovoNordisk, Resolution Therapeutics. Blanca Norero, Jaume Bosch, Annalisa Berzigotti, Susana G. Rodrigues have no conflicts of interest regarding this manuscript to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of studies in the systematic review following PRISMA guideline and recommendation.
See this image and copyright information in PMC

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