Therapeutic Value of Portal Vein Stenting before Chemoembolization for Treating Hepatocellular Carcinoma with Portal Vein Thrombosis

Abdelfatah, Ahmed Jameel; Alwarraky, Mohamed; Abo El-Fotouh, Mohammed; Abdel-Gawad, Mohamed Saied; Oda, Abdelmoaty Abdelkhalek; Ellaban, Heba Said

doi:10.21608/ijma.2025.342429.2078

Therapeutic Value of Portal Vein Stenting before Chemoembolization for Treating Hepatocellular Carcinoma with Portal Vein Thrombosis

Document Type : Original Article

Authors

¹ Department Interventional and Diagnostic Radiology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

² Department of Clinical Oncology and Nuclear Medicine, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

³ Department of Hepatolgy and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

10.21608/ijma.2025.342429.2078

Abstract

Background: Portal vein stenting [PVS] combined with transarterial chemoembolization [TACE] is a potential treatment strategy to improve outcomes in hepatocellular carcinoma [HCC] with portal vein tumor thrombosis [PVTT].
Aim of the work: This work evaluated the feasibility, safety, and therapeutic value of PVS followed by TACE for treating patients with HCC and PVTT.
Patients and methods: This prospective observational study involved patients with clinically diagnosed HCC and PVTT who underwent PVS followed by TACE. Patients were categorized into two groups based on the interval between PVS and TACE. Procedural metrics, clinical outcomes, stent patency, tumor progression, and survival rates were assessed.
Results: This study involved 54 patients. The mean stent patency duration was 18.36 ± 2.53 months. At the end of the study, stent occlusion was observed in 40 [67.8%] patients, tumor progression in 33 [55.9%] patients, and 40 [67.8%] patients died. The 1-year survival probability was 53.7% [95% CI: 41.9%–68.8%], declining to 33.3% [95% CI: 22.9%–48.6%] at 2 years, with a median survival of 381 days [95% CI: 316–661 days]. Stent patency probabilities were 42.6% [95% CI: 31.3%–58.1%] at 1 year and 25.9% [95% CI: 16.5%–40.7%] at 2 years, with a median patency duration of 243 days [95% CI: 115–556 days]. Child-Pugh classification, the number of TACE procedures, and group were significant predictors of better survival outcomes. For stent patency, HBV status, the number of TACE procedures, and group were significant predictors.
Conclusion: PVS followed by TACE is a feasible and effective therapeutic approach for HCC patients with PVTT. PVS facilitates sequential TACE. Stent patency and survival are influenced by liver function [Child-Pugh classification], number of TACE sessions, and group assignment.

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