{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T14:06:44Z","timestamp":1779026804396,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["RF\u20102021\u201012372399"],"award-info":[{"award-number":["RF\u20102021\u201012372399"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; Aims<\/jats:title>\n                    <jats:p>Portal hypertension is a major challenge in patients with cirrhosis requiring surgery. This study aimed to evaluate the efficacy of under\u2010dilated neoadjuvant transjugular intrahepatic portosystemic shunt (U.N\u2010TIPS) in enabling elective extrahepatic oncologic surgery in patients with cirrhosis and clinically significant portal hypertension (CSPH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter analysis included 34 patients who underwent U.N\u2010TIPS (diameter 5\u20137\u2009mm) between June 2018 and April 2023. The primary outcome was the ability of U.N\u2010TIPS to enable surgical interventions otherwise contraindicated. Secondary outcomes were perioperative complications, overt hepatic encephalopathy (OHE), heart failure, and survival rates at 6 months and 1 year post\u2010TIPS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, 53% of patients had decompensated cirrhosis. The most common malignancies were colorectal (32%) and gastric (15%). Final diameters were 5\/6\/7\u2009mm in 9\/17\/8 patients, respectively. Mean porto\u2010caval pressure gradient (PCPG) significantly decreased from 21\u2009\u00b1\u20094.5 to 11\u2009\u00b1\u20093.2\u2009mmHg (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with all patients achieving PCPG &lt;\u200916\u2009mmHg. Thirty\u2010two patients (94%) underwent planned surgery, with a median TIPS\u2010to\u2010surgery interval of 42\u2009days (IQR 45). Postoperative complications occurred in 38% of patients\u2014mostly infections\u2014and were independently associated with pre\u2010surgery MELD score and haemoglobin. Post\u2010TIPS OHE occurred in 22%, with no persistent cases; symptomatic heart failure developed in 6%. Six\u2010month and one\u2010year survival rates were 85% and 76%, respectively, without significant difference between pre\u2010TIPS compensated and decompensated patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.21).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>U.N\u2010TIPS represents an applicable strategy for enabling curative oncologic surgery in selected patients with cirrhosis and CSPH. Under\u2010dilation reduces shunt\u2010related complications while preserving hemodynamic efficacy, expanding TIPS applicability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact and Implications<\/jats:title>\n                    <jats:p>U.N\u2010TIPS addresses the critical barrier of portal hypertension in oncologic patients with cirrhosis, offering access to surgical treatments considered unfeasible while maintaining an adequate safety profile. These findings are particularly significant for hepatologists, oncologists, interventional radiologists, and surgeons managing the increasingly common clinical scenario of cirrhosis with concurrent extrahepatic malignancies. In clinical practice, our results support the implementation of multidisciplinary tumour boards that incorporate portal pressure assessment and TIPS indication in pre\u2010surgical planning. However, large, controlled studies are needed to compare outcomes between compensated patients with CSPH who undergo U.N\u2010TIPS versus those who do not receive this intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70473","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T10:57:12Z","timestamp":1765277832000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neoadjuvant Under\u2010Dilated\n                    <scp>TIPS<\/scp>\n                    : Expanding Surgeries for Extrahepatic Malignancies in Patients With Cirrhosis and\n                    <scp>CSPH<\/scp>"],"prefix":"10.1111","volume":"46","author":[{"given":"Dario","family":"Saltini","sequence":"first","affiliation":[{"name":"Severe Liver Diseases (M.E.C.) Departmental Unit, Department of Medical Specialties University Hospital of Modena \u201cPoliclinico\u201d, University of Modena and Reggio Emilia, European Reference Network on Rare Liver Disorders (ERN Rare\u2010Liver)  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Roccarina","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Senzolo","sequence":"additional","affiliation":[{"name":"Unit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences University\u2010Hospital of Padua  Padua Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Caporali","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology University Hospital of Modena \u201cPoliclinico\u201d  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Radiology Unit Careggi Hospital  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Severe Liver Diseases (M.E.C.) 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