Early Transjugular Intrahepatic Portosystemic Shunt for Advanced Hepatocellular Carcinoma

This study tests whether performing TIPS (transjugular intrahepatic portosystemic shunt — a procedure that relieves pressure in the liver's blood vessels) early — within 72 hours of an emergency bleeding episode — improves outcomes for people with advanced liver cancer that has blocked the main portal blood vessels. All patients also receive standard drug therapy (lenvatinib and PD-1 immunotherapy). **You may be eligible if...** - You have been diagnosed with primary liver cancer (hepatocellular carcinoma) - The cancer has blocked the main portal blood vessels (PVTT grade III–IV) - You had an emergency endoscopy to stop bleeding, and TIPS was done within 72 hours - Your cancer has spread to no more than 5 sites in no more than 2 organs - You are on lenvatinib and PD-1 immunotherapy as your first treatment - Your liver function is Child-Pugh class A or B **You may NOT be eligible if...** - You have had other cancers - Your liver function is severely compromised (Child-Pugh C) - You have uncontrolled infections or serious blood clotting problems Talk to your doctor to see if this trial is right for you.