Benjamin Menahem1, Jean Lubrano2, Aurélie Desjouis1, Vincent Lepennec2, Gil Lebreton1, Arnaud Alves3. 1. Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France. 2. Department of Radiology, University Hospital of Caen, Caen Cedex, France. 3. Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France. Electronic address: alves-a@chu-caen.fr.
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%. CONCLUSION: Portal decompression via TIPS placement may enable selected cirrhotic patients with severe portal hypertension to undergo colorectal resection for cancer.
BACKGROUND: Colorectal resection in cirrhoticpatients is associated with high mortality and morbidity related to portal hypertension and liver insufficiency. METHODS: This retrospective study evaluated the clinical outcomes of cirrhoticpatients 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%. CONCLUSION: Portal decompression via TIPS placement may enable selected cirrhoticpatients with severe portal hypertension to undergo colorectal resection for cancer.
Authors: N Tabchouri; L Barbier; B Menahem; J-M Perarnau; F Muscari; N Fares; L D'Alteroche; P-J Valette; J Dumortier; A Alves; J Lubrano; C Bureau; Ephrem Salamé Journal: J Gastrointest Surg Date: 2019-02-28 Impact factor: 3.452