Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2019; 7(13): 1599-1610
Published online Jul 6, 2019. doi: 10.12998/wjcc.v7.i13.1599
Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma
Shi-Hua Luo, Jian-Guo Chu, He Huang, Ke-Chun Yao
Shi-Hua Luo, Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Jian-Guo Chu, He Huang, Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China
Ke-Chun Yao, Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH and Huang H performed the research; Luo SH analyzed the data; Luo SH and Huang H wrote the paper; Yao KC revised the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, Beijing, China.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Guo Chu, MD, Professor, Department of Radiology, Air Force Medical Center of PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Telephone: +86-10-66928523 Fax: +86-10-66928523
Received: January 29, 2019
Peer-review started: January 29, 2019
First decision: March 14, 2019
Revised: April 10, 2019
Accepted: May 1, 2019
Article in press: May 1, 2019
Published online: July 6, 2019
ARTICLE HIGHLIGHTS
Research background

There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Tra-nsjugular intrahepatic portosystemic shunt (TIPS) has a good clinical effect in treating the complication of portal hypertension. Because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. They were compared with patients with cirrhosis and HCC who did not undergo TIPS placement. We conclude that TIPS combined with palliative treatment is safe and effective for portal hypertension in patients with HCC.

Research motivation

Liver cancer is often accompanied by cirrhosis, which often leads to the occurrence of liver cancer. TIPS can reduce portal pressure and relieve the clinical symptoms associated with various medical conditions. Because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We conducted a retrospective analysis of portal hypertension and liver cancer that were treated in our hospital with TIPS plus palliative treatment and radiofrequency ablation (RFA) and liver cancer patients treated with palliative treatment and RFA in order to compare the safety, efficacy, and survival rate between the two groups. In the future, randomized controlled trials are needed to verify our results.

Research objectives

The main objective of our study was to confirm our hypothesis that TIPS combined with palliative treatment and RFA for patients with HCC and portal hypertension is safe and effective, and it increases the survival rate of the patients.

Research methods

We conducted a retrospective study to compare the clinical efficacy of the combination of TIPS, transarterial TACE, RFA, and palliative treatment in liver cirrhosis complicated with HCC. The patients were divided into two groups. Group A comprised 217 patients with portal hypertension and HCC who were treated with TIPS plus palliative treatment and RFA. Group B comprised a cohort of 136 patients with HCC and portal hypertension who did not undergo TIPS placement and received palliative treatment and RFA. A logistic regression analysis was performed for the variables. The differences between the groups were compared using one-way analysis of variance followed by least significant difference t tests. Categorical variables were expressed as frequencies and compared using χ2 tests. Differences were considered significant at P < 0.05. The statistical analyses were performed with SPSS version 21.0 (SPSS, Armonk, NY, United States).

Research results

This study showed that TIPS combined with palliative treatment and RFA for patients with HCC and portal hypertension is safe. Mean survival and median survival were longer than in the group without TIPS treatment, which verified our hypothesis.

Research conclusions

TIPS combined with palliative treatment and RFA for patients with HCC and portal hypertension is safe and effective, and it prolongs the survival of the patients. We suggest that for patients with HCC and portal hypertension, TIPS procedure is not contraindicated in such circumstances of variceal bleeding and/or ascites. Patients with HCC and portal hypertension can be treated with TIPS procedure in future clinical practice.

Research perspectives

Based on the findings in this study that TIPS combined with palliative treatment and RFA for patients with HCC and portal hypertension is safe and effective and that it prolongs the survival of patients, patients with HCC and portal hypertension can be treated with TIPS. In future research, randomized controlled trials are needed to verify our results.