Portal vein stenting in recurrent or locally advanced peri-hilar cholangiocarcinoma.

Locally advanced peri-hilar cholangiocarcinoma Palliative treatment Portal hypertension Portal vein stenosis Recurrent peri-hilar cholangiocarcinoma Venous stent

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356

Informations de publication

Date de publication:
30 Jan 2024
Historique:
received: 21 11 2023
revised: 14 01 2024
accepted: 23 01 2024
medline: 10 2 2024
pubmed: 10 2 2024
entrez: 9 2 2024
Statut: aheadofprint

Résumé

Recurrent or locally advanced peri-hilar cholangiocarcinoma (PHCC) usually involves the portal vein (PV) leading to significant stenosis. With disease progression, clinical symptoms such as ascites, bleeding, and hepatic insufficiency are usually observed. Little is know about the benefit of PV stenting in relieving the symptoms associated to portal hypertension and allowing anticancer therapies. The aim of this study is to review our experience in PV stenting for PHCC patients. From 2014 to 2022, data from PHCC patients underwent PV stenting at Verona University Hospital, Italy, were reviewed. The indications were: gastrointestinal bleeding from esophagus-gastric varices, ascites not responsive to medical therapy, severe thrombocytopenia, liver insufficiency (hepatic jaundice, coagulopathy, and/or hyperammoniemia), or asymptomatic high-grade PV stenosis. Cavernous transformation and intrahepatic thrombosis in both sides of the liver were considered contraindication. Systematic anticoagulation therapy was not administered. Technical success was achieved in all 16 (100 %) patients. The improvement of clinical symptoms were observed in 12 (75 %) patients. Anticancer therapy was administrated in 11 (69 %) patients. 2 (13 %) complications were observed: 1 biliary injury and 1 recurrent cholangitis that required a percutaneous trans-hepatic biliary drainage placement. Stent occlusion for tumor progression occurred in 1 patient and a re-stenting procedure was successfully performed. No case of thrombotic stent occlusion was observed during follow up. The 1-year stent patency was 86 % and the median patency period was 8 months (IQR, 4-12). PV stenting is a feasible and safe palliative treatment that improves clinical condition, allow anticancer therapies, and provide a better quality of life.

Sections du résumé

BACKGROUND BACKGROUND
Recurrent or locally advanced peri-hilar cholangiocarcinoma (PHCC) usually involves the portal vein (PV) leading to significant stenosis. With disease progression, clinical symptoms such as ascites, bleeding, and hepatic insufficiency are usually observed. Little is know about the benefit of PV stenting in relieving the symptoms associated to portal hypertension and allowing anticancer therapies. The aim of this study is to review our experience in PV stenting for PHCC patients.
METHODS METHODS
From 2014 to 2022, data from PHCC patients underwent PV stenting at Verona University Hospital, Italy, were reviewed. The indications were: gastrointestinal bleeding from esophagus-gastric varices, ascites not responsive to medical therapy, severe thrombocytopenia, liver insufficiency (hepatic jaundice, coagulopathy, and/or hyperammoniemia), or asymptomatic high-grade PV stenosis. Cavernous transformation and intrahepatic thrombosis in both sides of the liver were considered contraindication. Systematic anticoagulation therapy was not administered.
RESULTS RESULTS
Technical success was achieved in all 16 (100 %) patients. The improvement of clinical symptoms were observed in 12 (75 %) patients. Anticancer therapy was administrated in 11 (69 %) patients. 2 (13 %) complications were observed: 1 biliary injury and 1 recurrent cholangitis that required a percutaneous trans-hepatic biliary drainage placement. Stent occlusion for tumor progression occurred in 1 patient and a re-stenting procedure was successfully performed. No case of thrombotic stent occlusion was observed during follow up. The 1-year stent patency was 86 % and the median patency period was 8 months (IQR, 4-12).
CONCLUSION CONCLUSIONS
PV stenting is a feasible and safe palliative treatment that improves clinical condition, allow anticancer therapies, and provide a better quality of life.

Identifiants

DOI: 10.1016/j.ejso.2024.107984 PMID: 38335874
pubmed: 38335874
pii: S0748-7983(24)00036-2
doi: 10.1016/j.ejso.2024.107984
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

107984

Informations de copyright

© 2024 Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of competing interest All authors state that they have no conflict of interest to disclose.

Auteurs

Mario De Bellis (M)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Alberto Contro (A)

Department of Diagnostics and Public Health, Unit of Radiology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Andrea Bianco (A)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Clizia Gasparini (C)

Department of Diagnostics and Public Health, Unit of Radiology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Marzia Tripepi (M)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Matilde La Raja (M)

Department of Diagnostics and Public Health, Unit of Radiology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Laura Alaimo (L)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Simone Conci (S)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Tommaso Campagnaro (T)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Alfredo Guglielmi (A)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Giancarlo Mansueto (G)

Department of Diagnostics and Public Health, Unit of Radiology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy.

Andrea Ruzzenente (A)

Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134, Verona, Italy. Electronic address: andrea.ruzzenente@univr.it.

Classifications MeSH