Pancreaticoduodenectomy in a patient with severe portal hypertension: the role of preoperative TIPS.
Carolina González-AbósEmmanuel Martínez EscalanteFrancisco Salgado MuñozHomero Charles CantúDeisy Navarrete EspinosaFilippo LandiBelén Martínez-MifsudAnna BaigesFabio AusaniaPublished in: Revista espanola de enfermedades digestivas (2024)
The complication rate for Pancreaticoduodenectomy (PD) is 40-50% in most published series and mortality can raise up to 4-5% even in high-volume centers. Severe portal hypertension secondary to liver disease is associated to high perioperative mortality and therefore is considered a contraindication for PD. No standardized management exists for surgically resectable patients with periampullary cancer and severe portal hypertension. The aim of this case study is to analyse the treatment alternatives in patients with periampullary cancer and severe portal hypertension and focus into the surgical treatment of these patients. We present the case of a 67 year-old patient case with a resectable ampullary cancer and portal hypertension managed with Preoperative Transjugular Intrahepatic Portosystemic Shunt (TIPS) to allow a PD. We present a literature review on the use of preoperative TIPS in patients who are candidates to PD. Neoadjuvant TIPS can be safely used in selected patients with severe portal hypertension who need a PD.
Keyphrases
- blood pressure
- end stage renal disease
- papillary thyroid
- early onset
- patients undergoing
- ejection fraction
- newly diagnosed
- case report
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- squamous cell
- cardiovascular events
- randomized controlled trial
- patient reported outcomes
- risk factors
- drug induced
- lymph node
- radiation therapy
- lymph node metastasis
- coronary artery disease
- cardiac surgery
- arterial hypertension
- pulmonary artery
- pulmonary arterial hypertension