Outcomes of transjugular intrahepatic portosystemic shunt creation for the management of portal hypertension complications in cancer patients.

PURPOSE

To evaluate the outcomes of Transjugular Intrahepatic Portosystemic Shunt (TIPS) or variations of portosystemic shunt creation procedure in cancer patients with portal hypertension (PHTN).

MATERIALS AND METHODS

A single-center retrospective study was performed on cancer patients who underwent TIPS from September 2016 through June 2023. Forty consecutive cancer patients (mean age 61 years; 30 men, 10 women) were reviewed. For each patient, data regarding indication, the Child-Pugh (C-P) classification, international normalized ratio (INR), serum bilirubin level, creatinine level, and Model for End-Stage Liver Disease (MELD) score before the procedure and 1 month after the procedure were collected. Clinical efficacy was evaluated based on response, defined as the absence of significant variceal bleeding or clinically detectable ascites or hydrothorax following TIPS placement. Technical safety, complications, overall survival (OS), and incidence of hepatic encephalopathy (HE) were also assessed.

RESULTS

One month after TIPS, 31 (77.5%) patients had clinical response, and 9 (22.5%) had no response. The technical success rate was 100%. There were no major procedure-related complications. The primary indications for shunt creation were ascites in 18 (45%), variceal bleeding (47.5%), and hydrothorax (7.5%). The 1-, 3-, and 6-month mortality rates were 10%, 25%, and 40%, respectively. Among the 40 patients included, 24 (60%) had cirrhosis, most commonly due to hepatitis C infection, hepatitis B infection, alcoholic liver disease, or NASH. The remaining 16 patients (40%) were non-cirrhotic. The median MELD score pre-TIPS was 11.5 (range 6.5-20.1). C-P score before intervention included 4 (10%) cases in class A, 33 (82.5%) in B, and 3 (7.5%) in C. The median OS was 15.4 months (range 0.03-61 months) and significantly differed by C-P score for each group (P < 0.001). No significant correlations existed between OS and the MELD score or pre-TIPS laboratory data. Fourteen patients developed HE (34%) after the procedure, and only one patient (2.5%) required shunt reduction. Responders had significantly longer OS, with a median of 26.5 months compared to 1.1 months in non-responders (P < 0.001, 95% CI: 2.14-13.19). Nine (22.5%) patients had a stent placed through the tumor. Twenty-six patients (65%) had an unchanged C-P class after the procedure, while C-P worsened in 6 (15%) and improved in 4 (10%).

CONCLUSION

These findings suggest that TIPS and its variations for the portosystemic shunt creation can be a safe and effective option for managing portal hypertension complications in carefully selected cancer patients with relatively preserved liver function. The study demonstrated high technical success and encouraging clinical response rates. Additionally, overall survival appeared longer in patients who responded to TIPS compared to non-responders.