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Liver resection after Transjugular Portosystemic Stent Shunt (TIPSS)
Svenja Sliwinski1, Jörg Trojan2, Christoph Mader3
1Department of General, Visceral, Transplant, and Thoracic Surgery, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
Zeitschrift Fur Gastroenterologie
|June 13, 2022
Summary
Liver resection following transjugular portosystemic stent shunt (TIPSS) placement for hepatocellular carcinoma (HCC) is possible. This case study demonstrates successful resection of an 11 cm HCC in a patient with prior TIPSS placement.
Area of Science:
- Hepatology
- Surgical Oncology
- Interventional Radiology
Background:
- Hepatocellular carcinoma (HCC) frequently develops in cirrhotic livers, where decompensated cirrhosis is typically a surgical contraindication.
- Liver resection for HCC in compensated cirrhosis carries significant risks of post-hepatectomy liver failure and cirrhosis decompensation.
- Transjugular portosystemic stent shunts (TIPSS) are standard for portal hypertension complications, but TIPSS presence is usually a contraindication for liver resection.
Purpose of the Study:
- To report the feasibility of liver resection in an intermediate-stage HCC patient with a previously placed TIPSS for decompensated cirrhosis.
- To challenge the current contraindication of TIPSS for liver resection in highly selected HCC cases.
Main Methods:
- A case report detailing the surgical approach and outcomes.
- Open liver resection was performed on an 11 cm intermediate HCC in a patient with a history of TIPSS placement for decompensated cirrhosis.
Main Results:
- Radical (R0) resection of the 11 cm HCC was achieved.
- The patient experienced an uncomplicated postoperative course and was discharged after 6 days.
Conclusions:
- Liver resection following TIPSS placement may be a viable option in highly selected HCC patients.
- This approach could expand treatment options for HCC in patients with portal hypertension and cirrhosis.
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