Risks and benefits of TIPS in HCC and other liver malignancies: a literature review

Background Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated treatment option for clinically significant portal hypertension (CSPH) in the context of liver cirrhosis. Its high efficacy and safety in the management of treatment-refractory ascites and variceal bleeding have been...

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Bibliographic Details
Published in:BMC gastroenterology 2023-11, Vol.23 (1), p.1-403, Article 403
Main Authors: Fichtl, Anna, Seufferlein, Thomas, Zizer, Eugen
Format: Article
Language:English
Subjects:
Ascites
Care and treatment
Cirrhosis
Clinically significant portal Hypertension (CSPH)
Congestive heart failure
Diagnosis
Endoscopy
Gastroenterology
Hepatic encephalopathy
Hepatocellular carcinoma
Hepatocellular carcinoma (HCC)
Hepatoma
Hypertension
Literature reviews
Liver cancer
Liver Cirrhosis
Liver diseases
Liver metastases
Liver transplantation
Malignancy
Medical prognosis
Metastasis
Metastatic seeding
Mortality
Observational studies
Patients
Prognosis
Remission (Medicine)
Sepsis
Thrombosis
Transjugular intrahepatic portosystemic shunt (TIPS)
Veins & arteries
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Summary:Background Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated treatment option for clinically significant portal hypertension (CSPH) in the context of liver cirrhosis. Its high efficacy and safety in the management of treatment-refractory ascites and variceal bleeding have been extensively proven. Contraindications for TIPS include severe right heart failure, hepatic encephalopathy, and sepsis. However, the role of liver malignancy in TIPS is debatable. Mostly, primary liver malignancies such as hepatocellular carcinoma (HCC) emerge from advanced liver diseases. Coexisting portal hypertension in HCC often results in limited treatment options and a poor prognosis. Summary Previous studies have shown that TIPS implantation in patients with HCC is technically feasible and is usually not associated with major adverse events. Furthermore, TIPS may help in bridging the time to liver transplantation in early HCC and allow for locoregional treatment in advanced HCC. However, several studies suggest that seeding tumour cells to the lungs by TIPS placement might worsen the prognosis. Conclusions TIPS placement in patients with coexisting liver malignancy remains a case-by-case decision, and there is no profound evidence allowing general recommendations. This review aims to provide a state-of-the-art overview of the potential risks and benefits of TIPS placement in patients with liver malignancies. Keywords: Transjugular intrahepatic portosystemic shunt (TIPS), Clinically significant portal Hypertension (CSPH), Hepatocellular carcinoma (HCC), Liver metastases, Liver Cirrhosis
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-023-03047-0