title: Transjugular intrahepatic portosystemic shunt placement increases feasibility of colorectal surgery in cirrhotic patients with severe portal hypertension.
abstract: BACKGROUND
  Colorectal resection in cirrhotic patients is associated with high mortality and morbidity related to portal hypertension and liver insufficiency.
  
  
  METHODS
  This retrospective study evaluated the clinical outcomes of cirrhotic patients who underwent transjugular intrahepatic porto-systemic shunt (TIPS) placement before colorectal resection for cancer. Main outcomes measures were postoperative morbidity and mortality rates.
  
  
  RESULTS
  TIPS placement was successful in all eight patients and significantly decreased the mean hepatic venous pressure gradient from 15.5 ± 2.9 to 7.5 ± 1.9 mmHg (p = 0.02). Surgical procedures included right colectomy (n = 3), left colectomy (n = 2), and proctectomy with total mesorectal excision (n=3). Post-operatively, two patients (25%) died of multiple organ failure. The overall postoperative morbidity rate was 75%, and major complications were seen in 25%.
  
  
  CONCLUSIONS
  Portal decompression via TIPS placement may enable selected cirrhotic patients with severe portal hypertension to undergo colorectal resection for cancer.
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Menahem
authors.affiliation: Department of Radiology, University Hospital of Caen, Caen Cedex, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Lubrano
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Desjouis
authors.affiliation: Department of Radiology, University Hospital of Caen, Caen Cedex, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepennec
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France.
authors.forename: Gil
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France. Electronic address: alves-a@chu-caen.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Colectomy; Liver insufficiency; Transjugular intrahepatic portosystemic shunt