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Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients
Author(s) -
Vibert Eric,
Azoulay Daniel,
Sa Cunha Antonio,
Adam Rene,
Samuel Didier,
Castaing Denis
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23306
Subject(s) - medicine , hepatocellular carcinoma , portal vein thrombosis , portal vein , cirrhosis , surgery , stent , percutaneous , trunk , thrombosis , portography , carcinoma , radiology , portal hypertension , gastroenterology , ecology , biology
Abstract Background and Aims Macroscopic portal vein invasion complicating hepatocellular carcinoma in the setting of cirrhosis is associated with a very low survival. To prevent the malignant progression from a portal branch to the main portal trunk, we have placed noncovered metallic stents extending from the portal trunk to the contralateral tumor free portal pedicle. Methods Fifty‐Four patients (age: 60 ± 11 years) were treated. Thirty‐four (60%) patients were Child A and 20 (40%) were Child B–C. Tumoral thrombosis involved 1st or 2nd order branches in 41 (82%) patients and partially the main trunk in 13 (24%). Open surgical insertion (via ileal vein) as an alternative to a percutaneous approach was used in 14 (24%) patients. Results Early mortality (<30 days) was 7%. Following stent insertion, a transarterial chemoembolization was performed in 26 (48%) patients. After stenting, overall survival at 6, 12, and 24 months were 47%, 44%, and 36%, respectively. Bilirubin > 30 µmol/L and open surgical insertion were predictive of short‐term mortality. In the good group, overall survival at 6, 12, and 24 months were 69%, 61%, and 46%, respectively. Conclusions The transhepatic deployment of metallic stent seems to improve survival of patients with hepatocellular carcinoma complicated by portal vein tumoral thrombosis and could allow subsequent treatments. J. Surg. Oncol. 2013;107:696–701. © 2012 Wiley Periodicals, Inc.