Transjugular intrahepatic portosystemic shunt for patients with hepatocellular carcinoma

Ten patients with hepatocellular carcinoma successfully underwent transjugular intrahepatic portosystemic shunt (TIPS) without technique-related complications. TIPS was indicated for massive ascites in six cases and ruptures of esophageal varices and hematemesis in four cases. Another two patients with massive ascites developed hepatocellular carcinoma between undergoing TIPS and follow-up observations after 12 and 30 months. In 10 of these 12 patients, the results of TIPS were satisfactory, having obtained good flow in the shunt and effective portal decompression. The gastrointestinal bleeding stopped in all four patients, and the uncontrollable ascites disappeared or decreased in six of the eight patients. Seven out of the 12 patients survived and were followed up for from 2 to 31 months after the TIPS procedure. After TIPS, five patients died due to tumor progression (three patients), hepatic failure (one patient) or acute hepatititis (one patient). In one other patient, the tumor ruptured one month after TIPS was performed. It is concluded that TIPS is a useful and safe treatment for portal hypertension, even in patients with hepatocellular carcinoma as long as it is not located in the puncture route. However, TIPS should be performed only in patients whose tumors have already been controlled by hepatic embolization and/or ethanol injection therapy. Careful follow-up observation is needed after the procedure on a longterm basis.