Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt

Short-Term Oral Sorafenib for Therapy of Intratumoral Shunts of Hepatocellular Carcinoma to Enable Intraarterial Treatment

INTRODUCTION

Significant intratumoral shunts between tumor-supplying arteries and portal or liver veins are a contraindication for transarterial therapy of HCC because interventional treatment of these shunts is frequently insufficient. Sorafenib has anti-angiogenic effects and is indicated for palliative treatment of patients with HCC. Here, we report our experience with the use of sorafenib for the closure of intratumoral shunts in patients scheduled for transarterial therapy of HCC.

MATERIALS AND METHODS

Three patients with HCC, aged 65, 82 and 79 years, exhibited a significant intratumoral shunting from tumor artery to portal (n = 1) or liver veins (n = 2). In all cases, intratumoral shunting had already been suspected based on pre-interventional CT angiography, and DSA confirmed the shunt. Oral sorafenib (800 mg/day) was administered for at least four weeks, only and specifically to occlude the shunt. Hereafter, patients were re-evaluated by CT and DSA.

RESULTS

All patients tolerated the full prescribed dose for at least 4 weeks. In one case, therapy was prolonged with an adapted dose (400 mg/day) due to sorafenib-related hand-foot syndrome. After sorafenib treatment, CT and DSA confirmed a complete closure of intratumoral shunts for all patients. No tumor progression was observed. All three patients hereafter underwent successful transarterial treatment by TACE (n = 2) or TARE (n = 1) without complications. Progression-free survival according to mRECIST was 501, 397 and 599 days, respectively.

CONCLUSION

Even short-term oral sorafenib seems to effectively close intratumoral shunts in patients with HCC and thus might enable transarterial treatment of these patients.

Efficacy and safety of hood-assisted endoscopic injection sclerotherapy in patients with cirrhosis and esophageal varices

AIM: To evaluate the efficacy and safety of hood-assisted endoscopic esophageal injection sclerotherapy (EIS) in cirrhotic patients with esophageal varices.

METHODS: Seventy-eight cirrhotic patients with esophageal varices treated by EIS were divided into two groups: 47 patients (group A) were treated by direct injection and 31 by hood-assisted endoscopy (group B). The changes in endoscopic characteristics of esophageal varices, the time required to perform endoscopic treatment, and other complications were compared between the two groups. The patients were followed 1, 6, and 12 mo after treatment.

RESULTS: The hood-assisted EIS method might improve efficacy compared with the direct injection group (group B: 96.8% vs group A: 74.5%, P < 0.05). The smaller volume of sclerosant was required to eradicate varices in the hood-assisted EIS group (80.54 mL ± 18.72 mL vs 60.54 mL ± 12.74 mL, P < 0.05). The sessions of sclerotherapy (4.78 times ± 1.24 times vs 2.78 times ± 1.24 times, P < 0.05), the time required to perform endoscopic treatment (8.26 min ± 1.45 min vs 5.27 min ± 1.63 min, P < 0.05) and the incidence of complications were significantly reduced in the hood-assisted group.

CONCLUSION: Our preliminary results indicate that the hood-assisted EIS method may reduce the risk of variceal bleeding during EIS and improve the efficacy of EIS.

Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding: a case report

It is reported the case of a 69 years man who presented to the Emergency Room because of pain and abdominal distension from ascites. After admission and paracentesis placement, he developed a digestive hemorrhage due to oesophageal varices from portal ipertension secondary to the formation of a portal shunt concomitant with a multifocal HepatoCellular Carcinoma (HCC) with portal vein thrombosis (PVT). The patient underwent endoscopic varices ligation, twice transarterial embolization (TAE) of arterial branches feeding the shunt and subsequent left hepatectomy. During the postoperative course he developed mild and transient signs of liver failure and was discharged in postoperative day 16. He is alive and disease free 8 months after surgery.