Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score-Matched Study

Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Postsurgical Portal Vein Stenosis

PURPOSE

To investigate the change in serum albumin (Alb) levels and hepatic reserve scores before and after portal vein stent placement (PVS) for postsurgical portal vein (PV) stenosis.

MATERIALS AND METHODS

A retrospective cohort of patients who underwent PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by PV patency at final portography) were evaluated. Alb, prothrombin time-international ratio (PT-INR), total bilirubin (Tbili), platelet (Plt) counts, Child-Pugh scores (CPS), and Alb-bilirubin (ALBI) scores/grades before and 1 month after PVS were compared. Normally distributed variables were summarized as mean ± standard deviation (SD) and compared with paired t-tests. Skewed variables were summarized as median (interquartile range) and compared with the signed-rank tests.

RESULTS

Twenty-five patients (mean age, 61 years [SD ± 10]; female, 44%) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: the Alb levels increased from 3.1 g/dL (SD ± 0.6) to 3.5 g/dL (SD ± 0.5) (P = .006), with greatest change in patients with pre-PVS Alb levels of ≤2.9 g/dL (2.6 g/dL ± 0.3 to 3.3 g/dL ± 0.4, P < .001). Improvements in CPS (P = .026), ALBI score (P = .002), and ALBI grades (P = .026) were observed. PT-INR elongated (1.2 [1.1-1.3] to 1.3 [1.2-1.6], P = .002), mainly because of patients receiving post-PVS warfarin (P = .005 and P = .20 for with and without warfarin, respectively). No significant changes were observed for Tbili (P = .40) and Plt counts (P = .25).

CONCLUSIONS

Improvements of liver synthetic function represented by serum Alb levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.

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

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

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

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

PV stenting is a feasible and safe palliative treatment that improves clinical condition, allow anticancer therapies, and provide a better quality of life.