Alimentary Pharmacology and Therapeutics Invited Editorials
Editorial: TIPSS in patients with cirrhosis and hepatocellular carcinoma – authors’ reply D. Bettinger*, E. Kn€ uppel*, W. Euringer†, H. C. Spangenberg*, M. R€ ossle*,‡, R. Thimme* & M. Schultheiß* *Department of Medicine II, University Hospital Freiburg, Freiburg, Germany. † Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany. ‡ PraxisZentrum f€ ur Gastroenterologie und Endokrinologie, Freiburg, Germany. E-mail: [email protected] doi:10.1111/apt.13038
With great interest, we read the editorial by Rowe and Tripathi and thank the authors for their comments concerning our paper published in the current issue of AP&T.1, 2 Patients with end-stage liver disease are often affected by portal hypertension and hepatocellular carcinoma (HCC). Symptomatic portal hypertension (SPH) is associated with impaired survival in HCC patients. In our retrospective observation study investigating TIPSS implantation in HCC patients, we were able to show a good clinical control of SPH in HCC patients, especially in those with small HCC.2 As the authors state correctly, our patients were highly selected and the decision to perform TIPSS implantation was made on an individual basis. Due to the retrospective design of our study, it was not entirely possible to evaluate the absolute contraindications in patients with HCC and SPH who were not allocated to TIPSS implantation. However, main contraindications
Aliment Pharmacol Ther 2015; 41: 227-231 ª 2014 John Wiley & Sons Ltd
included uncontrolled tumour growth and poor performance status of a given patient, but absolute and relative contraindications need to be clearly defined in further studies. Indeed, another important issue to be investigated will be the role of TIPSS implantation in patients with malignant portal vein thrombosis in HCC patients. Furthermore, Rowe and Tripathi point out that it will be important to stratify these patients according to the BCLC classification to determine overall survival. We fully agree with this comment and indeed further studies are needed that include a control group of HCC patients with SPH, who are therefore treated with medical or endoscopic treatment. In our opinion, it will be important to focus on patients with BCLC A suffering from SPH and are therefore not allocated to curative surgical resection. TIPSS may resolve SPH and thus, these patients may be allocated to surgery. Further prospective studies including a control group should focus on this important issue. In summary, our retrospective observation study highlights several important points and clinical relevant aspects, which can be evaluated in further well-designed prospective studies.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Rowe IA, Tripathi D. TIPSS in patients with cirrhosis and hepatocellular carcinoma. Aliment Pharmacol Ther 2015; 41: 230. 2. Bettinger D, Knuppel E, Euringer W, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2015; 41: 126–36.
231
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Editorial: TIPSS in patients with cirrhosis and hepatocellular carcinoma – authors’ reply D. Bettinger*, E. Kn€ uppel*, W. Euringer†, H. C. Spangenberg*, M. R€ ossle*,‡, R. Thimme* & M. Schultheiß* *Department of Medicine II, University Hospital Freiburg, Freiburg, Germany. † Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany. ‡ PraxisZentrum f€ ur Gastroenterologie und Endokrinologie, Freiburg, Germany. E-mail: [email protected] doi:10.1111/apt.13038
With great interest, we read the editorial by Rowe and Tripathi and thank the authors for their comments concerning our paper published in the current issue of AP&T.1, 2 Patients with end-stage liver disease are often affected by portal hypertension and hepatocellular carcinoma (HCC). Symptomatic portal hypertension (SPH) is associated with impaired survival in HCC patients. In our retrospective observation study investigating TIPSS implantation in HCC patients, we were able to show a good clinical control of SPH in HCC patients, especially in those with small HCC.2 As the authors state correctly, our patients were highly selected and the decision to perform TIPSS implantation was made on an individual basis. Due to the retrospective design of our study, it was not entirely possible to evaluate the absolute contraindications in patients with HCC and SPH who were not allocated to TIPSS implantation. However, main contraindications
Aliment Pharmacol Ther 2015; 41: 227-231 ª 2014 John Wiley & Sons Ltd
included uncontrolled tumour growth and poor performance status of a given patient, but absolute and relative contraindications need to be clearly defined in further studies. Indeed, another important issue to be investigated will be the role of TIPSS implantation in patients with malignant portal vein thrombosis in HCC patients. Furthermore, Rowe and Tripathi point out that it will be important to stratify these patients according to the BCLC classification to determine overall survival. We fully agree with this comment and indeed further studies are needed that include a control group of HCC patients with SPH, who are therefore treated with medical or endoscopic treatment. In our opinion, it will be important to focus on patients with BCLC A suffering from SPH and are therefore not allocated to curative surgical resection. TIPSS may resolve SPH and thus, these patients may be allocated to surgery. Further prospective studies including a control group should focus on this important issue. In summary, our retrospective observation study highlights several important points and clinical relevant aspects, which can be evaluated in further well-designed prospective studies.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Rowe IA, Tripathi D. TIPSS in patients with cirrhosis and hepatocellular carcinoma. Aliment Pharmacol Ther 2015; 41: 230. 2. Bettinger D, Knuppel E, Euringer W, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2015; 41: 126–36.
231
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
