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J Surg Oncol. 2013 Jun;107(7):696-701. doi: 10.1002/jso.23306. Epub 2012 Dec 31.

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

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1
AP-HP, Hopital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.

Abstract

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.

PMID:
23280593
DOI:
10.1002/jso.23306
[Indexed for MEDLINE]
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