Conflict of interest: none.
Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients†
Article first published online: 31 DEC 2012
Copyright © 2012 Wiley Periodicals, Inc.
Journal of Surgical Oncology
Volume 107, Issue 7, pages 696–701, June 2013
How to Cite
Vibert, E., Azoulay, D., Sa Cunha, A., Adam, R., Samuel, D. and Castaing, D. (2013), Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients. J. Surg. Oncol., 107: 696–701. doi: 10.1002/jso.23306
- Issue published online: 25 MAY 2013
- Article first published online: 31 DEC 2012
- Manuscript Accepted: 19 NOV 2012
- Manuscript Received: 8 JUN 2012
- hepatocellular carcinoma;
- portal vein thrombosis;
- portal stent;
- metallic stent;
- macroscopic portal vein invasion;
- tumoral thrombus;
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.
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.
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.
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.