title: Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients.
abstract: OBJECTIVE
  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.
authors.affiliation: AP-HP, Hopital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein / Q000473:pathology; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency