Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients.

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.