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

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 transj...

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Autores principales: Yan, Xuan-Hui, Yue, Zhen-Dong, Zhao, Hong-Wei, Wang, Lei, Fan, Zhen-Hua, Wu, Yi-Fan, Meng, Ming-Ming, Zhang, Ke, Jiang, Li, Ding, Hui-Guo, Zhang, Yue-Ning, Yang, Yong-Ping, Liu, Fu-Quan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258232/
https://www.ncbi.nlm.nih.gov/pubmed/35979417
http://dx.doi.org/10.4240/wjgs.v14.i6.567
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author Yan, Xuan-Hui
Yue, Zhen-Dong
Zhao, Hong-Wei
Wang, Lei
Fan, Zhen-Hua
Wu, Yi-Fan
Meng, Ming-Ming
Zhang, Ke
Jiang, Li
Ding, Hui-Guo
Zhang, Yue-Ning
Yang, Yong-Ping
Liu, Fu-Quan
author_facet Yan, Xuan-Hui
Yue, Zhen-Dong
Zhao, Hong-Wei
Wang, Lei
Fan, Zhen-Hua
Wu, Yi-Fan
Meng, Ming-Ming
Zhang, Ke
Jiang, Li
Ding, Hui-Guo
Zhang, Yue-Ning
Yang, Yong-Ping
Liu, Fu-Quan
author_sort Yan, Xuan-Hui
collection PubMed
description 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 (125)I 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.
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spelling pubmed-92582322022-08-16 Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension Yan, Xuan-Hui Yue, Zhen-Dong Zhao, Hong-Wei Wang, Lei Fan, Zhen-Hua Wu, Yi-Fan Meng, Ming-Ming Zhang, Ke Jiang, Li Ding, Hui-Guo Zhang, Yue-Ning Yang, Yong-Ping Liu, Fu-Quan World J Gastrointest Surg Retrospective Cohort Study 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 (125)I 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. Baishideng Publishing Group Inc 2022-06-27 2022-06-27 /pmc/articles/PMC9258232/ /pubmed/35979417 http://dx.doi.org/10.4240/wjgs.v14.i6.567 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Cohort Study
Yan, Xuan-Hui
Yue, Zhen-Dong
Zhao, Hong-Wei
Wang, Lei
Fan, Zhen-Hua
Wu, Yi-Fan
Meng, Ming-Ming
Zhang, Ke
Jiang, Li
Ding, Hui-Guo
Zhang, Yue-Ning
Yang, Yong-Ping
Liu, Fu-Quan
Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title_full Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title_fullStr Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title_full_unstemmed Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title_short Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
title_sort transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258232/
https://www.ncbi.nlm.nih.gov/pubmed/35979417
http://dx.doi.org/10.4240/wjgs.v14.i6.567
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