Title: Risks and Benefits of TIPS in HCC and Other Liver Malignancies: a literature review
Version: 0 Date: 24 Jul 2023
Reviewer's report:
This is a clinically useful review on the efficacy and safety of TIPS in (mostly) HCC patients.
It is well structured and at the end of separate paragraphe there is a main message, which helps
the reader.
Of course despite the title "...and other liver malignancies" it is mostly focused -as expected-
in HCC. There are very few data for cholangio carcinoma, is this correct? For extrahepatic
malignancies there is an informative paragraph at the end of the analysis.
As  regards HCC, in the past a centrally located HCC was considered a (relative)
contraindication. What is the authors' impression on this?
Studies that were analyzed had at the exclusion criteria tumor >70% of the liver. This is really
too advanced. However, could we accept patients with tumors with 50 or 60% can easily go to
TIPS procedure (for any indication)? Should be an upper limit? What about the multifocality?
Was there any impact for TIPS placement?
In respect to the liver dysfunction deterioration, in which group of HCC patients that underwent
TIPS procedure, could the authors identify a high risk cut off (in Child's or MELD) that might
do the approach questionable?
Moreover, it is stressed that TIPS placement offered survival benefit, providing the opportunity
for HCC patients to receive TKI treatments. Presumably, this might apply -in a greater extent-
probably in immunotherapy approaches.
It would be also useful to identify, albeit difficult due to the nature of the study, to see what
percentage of HCC patients underoing to TIPS, did manage to receive a radical treatment for
their tumors.
There is no clear report of stenosis or TIPS dysfunction in the paper. This is something expected
as the paper has included studied from years ago, when the expertise and the quality of the stents
were not the same as they are now.
Title: Risks and Benefits of TIPS in HCC and Other Liver Malignancies: a literature review
Version: 0 Date: 24 Jul 2023
Reviewer's report:
This is a clinically useful review on the efficacy and safety of TIPS in (mostly) HCC patients.
It is well structured and at the end of separate paragraphe there is a main message, which helps
the reader.
Of course despite the title "...and other liver malignancies" it is mostly focused -as expected-
in HCC. There are very few data for cholangio carcinoma, is this correct? For extrahepatic
malignancies there is an informative paragraph at the end of the analysis.
As  regards HCC, in the past a centrally located HCC was considered a (relative)
contraindication. What is the authors' impression on this?
Studies that were analyzed had at the exclusion criteria tumor >70% of the liver. This is really
too advanced. However, could we accept patients with tumors with 50 or 60% can easily go to
TIPS procedure (for any indication)? Should be an upper limit? What about the multifocality?
Was there any impact for TIPS placement?
In respect to the liver dysfunction deterioration, in which group of HCC patients that underwent
TIPS procedure, could the authors identify a high risk cut off (in Child's or MELD) that might
do the approach questionable?
Moreover, it is stressed that TIPS placement offered survival benefit, providing the opportunity
for HCC patients to receive TKI treatments. Presumably, this might apply -in a greater extent-
probably in immunotherapy approaches.
It would be also useful to identify, albeit difficult due to the nature of the study, to see what
percentage of HCC patients underoing to TIPS, did manage to receive a radical treatment for
their tumors.
There is no clear report of stenosis or TIPS dysfunction in the paper. This is something expected
as the paper has included studied from years ago, when the expertise and the quality of the stents
were not the same as they are now.
Please review this paper.
user
Title: Risks and Benefits of TIPS in HCC and Other Liver Malignancies: a literature review
Version: 0 Date: 24 Jul 2023
Reviewer's report:
This is a clinically useful review on the efficacy and safety of TIPS in (mostly) HCC patients.
It is well structured and at the end of separate paragraphe there is a main message, which helps
the reader.
Of course despite the title "...and other liver malignancies" it is mostly focused -as expected-
in HCC. There are very few data for cholangio carcinoma, is this correct? For extrahepatic
malignancies there is an informative paragraph at the end of the analysis.
As  regards HCC, in the past a centrally located HCC was considered a (relative)
contraindication. What is the authors' impression on this?
Studies that were analyzed had at the exclusion criteria tumor >70% of the liver. This is really
too advanced. However, could we accept patients with tumors with 50 or 60% can easily go to
TIPS procedure (for any indication)? Should be an upper limit? What about the multifocality?
Was there any impact for TIPS placement?
In respect to the liver dysfunction deterioration, in which group of HCC patients that underwent
TIPS procedure, could the authors identify a high risk cut off (in Child's or MELD) that might
do the approach questionable?
Moreover, it is stressed that TIPS placement offered survival benefit, providing the opportunity
for HCC patients to receive TKI treatments. Presumably, this might apply -in a greater extent-
probably in immunotherapy approaches.
It would be also useful to identify, albeit difficult due to the nature of the study, to see what
percentage of HCC patients underoing to TIPS, did manage to receive a radical treatment for
their tumors.
There is no clear report of stenosis or TIPS dysfunction in the paper. This is something expected
as the paper has included studied from years ago, when the expertise and the quality of the stents
were not the same as they are now.
assistant