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Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

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World Journal of Gastroenterology 2019年第43期25卷 6373-6385页

作者： Kin Pan Au albert chi yan chan Department of Surgery Queen Mary HospitalHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver *** offers patients with insufficient liver function a chance of a *** is most controversial when its high morbidity and mortality is *** mortality is usually a result of posthepatectomy liver failure and can be minimized with careful patient *** patients have limited reserve for tolerating the demanding *** with colorectal liver metastasis have normal liver and are ideal *** for cholangiocarcinoma is technically challenging and associated with fair *** with hepatocellular carcinoma have chronic liver disease and limited parenchymal ***,in selected patients with limited hepatic fibrosis satisfactory outcomes have been *** the inter-stage period,serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage *** growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II *** outcomes of ALPPS have been improved by a combination of technical *** patients with challenging anatomy,partial ALPPS potentially reduces morbidity,but remnant hypertrophy may compare unfavorably to a complete *** compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation,ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or *** ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy,the long-term outcomes are yet to be determined.

关键词： Associating liver partition with portal vein ligation for staged hepatectomy Two-stage hepatectomy Patient selection Surgical outcomes

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Simultaneous portohepatic vein embolization a radiological:a short cut to associating liver partition and portal vein ligation for staged hepatectomy?

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 373-375页

作者： Ka Wing Ma albert chi yan chan Department of Surgery Li Ka Shing Faculty of Medicinethe University of Hong KongHong KongChina

Insufficient future liver remnant(FLR)represented one of the most common contraindications for major hepatectomy as post-hepatectomy liver failure(PHLF)was associated with high mortality with no effective *** the description of portal vein embolization(PVE)by Makucchi in 1984(1),FLR volumetric modulation was made *** of PVE before major hepatectomy for patients with insufficient FLR(i.e.,<30%of estimated standard liver volume)had greatly improved resectability.

关键词： hepatectomy mortality liver

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Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation

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World Journal of Clinical Cases 2020年第13期8卷 2758-2768页

作者： Kin Pan Au chi Leung chiang albert chi yan chan Tan To Cheung Chung Mau Lo Kenneth Siu Ho Chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong Kong 999077China Department of Clinical Oncology Queen Mary Hospitalthe University of Hong KongHong Kong 999077China

BACKGROUND Graft hepatocellular carcinoma(HCC)recurrence after liver transplant is more frequently *** hepatectomy is technically challenging and is associated with high *** body radiation therapy(SBRT)has been shown to be safe and effective for the treatment of primary ***,its role in HCC recurrence in a liver graft remains *** To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver *** A retrospective study was *** 2012 to 2018,6 patients with intrahepatic HCC recurrence after liver transplant were treated with SBRT at Queen Mary Hospital,the University of Hong *** primary outcome was time to overall disease progression and secondary outcomes were time to local progression and best local response,as assessed with the Modified response Evaluation Criteria for Solid Tumours *** were monitored for treatment related toxicities and graft *** A total of 9 treatment courses were given for 13 *** median tumour size was 2.3 cm(range 0.7-3.6 cm).Two(22%)patients had inferior vena cava tumour *** best local treatment response was:5(55%)complete response,1(11%)partial response and 3(33%)stable *** a median follow up duration of 15.5 mo,no local progression or mortality was yet *** median time to overall disease progression was 6.5 *** were 6 regional progression in the liver graft(67%)and 2 distant progression in the lung(22%).There was no grade 3 or above toxicity and there was no graft dysfunction after *** SBRT appears to be safe in this *** progression is the mode of failure.

关键词： Stereotactic body radiotherapy Hepatocellular carcinoma Liver transplantation Recurrence Radiosurgery Outcomes

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The ‘Unsigned highway’:An alternative route for portal vein anastomosis for non-malignant portal vein thrombosis during pediatric re-transplantation

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 193-195页

作者： albert chi yan chan Wing chiu Dai Patrick Ho Yu Chung Wong Hoi She Sui Ling Sin Division of Liver Transplantation Department of SurgeryThe University of Hong KongHong KongChina Division of Paediatric Surgery Department of SurgeryThe University of Hong KongHong KongChina

To the Editor:Non-malignant portal vein thrombosis(PVT)remains an important issue in liver transplantation due to the technical challenges in re-establishing the portal flow to the liver *** prevalence of complex PVT(*** grade 4)was reported to be around 2.0%[1].In the early history of liver transplantation,PVT was regarded as a contraindication.

关键词： malignant thrombosis anastomosis

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Solitary extraovarian primary peritoneal carcinoma with direct invasion into the liver,diaphragm and lung without peritoneal dissemination or distant metastasis

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 322-325页

作者： Billy Ho Hung Cheung Wong Hoi She Siu Lun Ho albert chi yan chan Chung Mau Lo Tan To Cheung Department of Surgery The University of Hong KongHong KongChina Department of Pathology The University of Hong KongHong KongChina

To the Editor:Extraovarian primary peritoneal carcinoma(EOPPC)is an uncommon malignancy with many similarities to epithelial ovarian carcinoma in histological,clinical,and etiological aspects[1].This phenomenon is explained by their common embryonal origin,in which both develop from the coelomic epithelium in the early embryological *** their similarities,the incidence of EOPPC is significantly lower than that of epithelial ovarian carcinoma(6.78 cases per million vs.120.5 cases per million)[1].

关键词： peritoneal invasion metastasis

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Survival outcomes of liver transplantation for hepatocellular carcinoma in patients with normal, high and very high preoperative alpha-fetoprotein levels

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World Journal of Hepatology 2018年第2期10卷 308-318页

作者： Wong Hoi She albert chi yan chan Tan To Cheung Chung Mau Lo Kenneth Siu Ho Chok Department of Surgery University of Hong Kong Department of Surgery and State Key Laboratory for Liver Research University of Hong Kong

AIM To investigate the impact of alpha-fetoprotein(AFP) on long-term recurrence rate and overall survival and we also aimed to define the level of AFP leading to a higher risk of disease recurrence and affecting patient *** Data of adult patients who received liver transplant(LT) for hepatocellular carcinoma(HCC) at our hospital from January 2000 to December 2013 were reviewed. Reviewed data included demographic characteristics, preoperative AFP level, operative details, follow-up details, and survival outcomes. Patients were mostly listed for LT based on Milan or UCSF criteria. For the purpose of this study, normal AFP level was defined as AFP value < 10 ng/m L, high AFP level was defined as AFP value ≥ 10 to < 400 ng/m L, and very highAFP level was defined as AFP ≥ 400 ng/m L. The patients were divided into these 3 groups accordingly. Survival rates were plotted as Kaplan-Meier curves and compared by log-rank analysis. Continuous variables were expressed as median(interquartile range). Categorical variables were compared by Spearman's test. Discriminative analysis was used to define the lowest value of AFP that could affect the overall survival in study population. Statistical significance was defined by a P value of < *** Totally 250 adult patients underwent LT for HCC in the study period. Eight-four of them received deceaseddonor LT and 166 had living-donor LT. The patients were divided into 3 groups: Group A, AFP < 10 ng/m L(n = 83); Group B, AFP ≥ 10 to < 400 ng/m L(n = 131); Group C, AFP ≥ 400 ng/m L(n = 36). The commonest etiology was hepatitis-B-related cirrhosis. The Model for End-stage Liver Disease scores in these groups were similar(median, 13 vs 13 vs 12; P = 0.745). The time to operation in Group A was longer(median, 94 vs 31 vs 35 d; P = 0.001). The groups were similar in hospital mortality(P = 0.626) and postoperative complication(P = 0.702). Pathology of explants showed that the 3 groups had similar numbers of tumor nodules, b

关键词： Alpha-fetoprotein Liver transplantation Recurrence Survival

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Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population

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World Journal of Gastrointestinal Oncology 2019年第4期11卷 322-334页

作者： Ka Wing Ma Wong Hoi She albert chi yan chan Tan To Cheung James yan Yue Fung Wing chiu Dai Chung Mau Lo Kenneth Siu Ho Chok Department of Surgery the University of Hong Kong Department of Surgery and State Key Laboratory for Liver Research the University of Hong Kong Department of Medicine and State Key Laboratory for Liver Research The University of Hong Kong

BACKGROUND Liver transplantation(LT) is regarded as the best treatment for both primary and recurrent hepatocellular carcinoma(HCC). Post-transplant HCC recurrence rate is relatively low but significant, ranging from 10%-30% according to different series. When recurrence happens, it is usually extrahepatic and associated with poor prognosis. A predictive model that allows patient stratification according to recurrence risk can help to individualize post-transplant surveillance protocol and guidance of the use of anti-tumor immunosuppressive *** To develop a scoring system to predict HCC recurrence after LT in an Asian *** Consecutive patients having LT for HCC from 1995 to 2016 at our hospital were recruited. They were randomized into the training set and the validation set in a60:40 ratio. Multivariable Cox regression model was used to identity factors associated with HCC recurrence. A risk score was assigned to each factor according to the odds ratio. Accuracy of the score was assessed by the area under the receiver operating characteristic *** In total, 330 patients were eligible for analysis(183 in training and 147 invalidation). Recurrent HCC developed in 14.2% of them. The median follow-up duration was 65.6 mo. The 5-year disease-free and overall survival rates were78% and 80%, respectively. On multivariate analysis, alpha-fetoprotein > 400 ng/mL [P = 0.012, hazard ratio(HR) 2.92], sum of maximum tumor size and number(P = 0.013, HR 1.15), and salvage LT(P = 0.033, HR 2.08) were found to be independent factors for disease-free survival. A risk score was calculated for each patient with good discriminatory power(c-stat 0.748 and 0.85, respectively,in the training and validation sets). With the derived scores, patients were classified into low-(0–9), moderate-(> 9–14), and high-risk groups(> 14), and the risk of HCC recurrence in the training and validation sets was 10%, 20%, 54%(cstat 0.67) and 4%, 22%, 62%(c-stat 0.811), accordin

关键词： Hepatocellular carcinoma Liver transplantation Post-transplant recurrence Predictive model

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Liver transplantation:would it be the best and last chance of cure for hepatocellular carcinoma with major venous invasion?

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 308-314页

作者： Ka Wing Ma albert chi yan chan Kenneth Siu Ho Chok Wong Hoi She Tan To Cheung Wing chiu Dai James yan Yue Fung Chung Mau Lo Department of Surgery The University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina

Background:Hepatocellular carcinoma(HCC)with portal vein tumour thrombus(PVTT)signifies advanced disease,whether LT confers any survival superiority over resection remains ***:A propensity score matched(PSM)analysis of liver transplantation(LT)and liver resection(LR)for HCC with PVTT was ***:A consecutive series of 88 patients who received either LT(10 DDLTs and 3 LDLTs)or LR(n=75)respectively were *** PSM,the LT group has a higher MELD score(17.3 vs.7.8,Pching for serum AFP levels and tumour size,1-,3-and 5-year overall survival for LT were 81 ng/mL,3.9 cm,80%,70%and 70%and the corresponding rates for LR were 1,417 ng/mL,5.3 cm,51.8%,19,6%and 9.8%(P value=0.12,0.27 and 0.009 respectively).Conclusions:LT is associated with significantly better oncological outcomes in HCC patients with PVTT involving the lobar or segmental level.A modest expansion of selection criteria to include small HCC with segmental PVTT should be considered.

关键词： Liver transplantation(LT) portal vein tumour thrombus liver resection(LR)Submitted Aug 10,2019.Accepted for publication Oct 15,2019.

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Impact of small-for-size liver grafts on medium-term and long-term graft survival in living donor liver transplantation: A meta-analysis

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World Journal of Gastroenterology 2019年第36期25卷 5559-5568页

作者： Ka Wing Ma Kelly Hiu ching Wong albert chi yan chan Tan To Cheung Wing chiu Dai James yan Yue Fung Wong Hoi She Chung Mau Lo Kenneth Siu Ho Chok Department of Surgery Queen Mary Hospital Hong Kong China Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong China Department of Surgery The University of Hong Kong Hong Kong China Department of Medicine Queen Mary Hospital Hong Kong China

BACKGROUND Small-for-size grafts (SFSGs) in living donor liver transplantation (LDLT) could optimize donor postoperative outcomes and also expand the potential donor pool. Evidence on whether SFSGs would affect medium-term and long-term recipient graft survival is lacking. AIM To evaluate the impact of small-for-size liver grafts on medium-term and longterm graft survival in adult to adult LDLT. METHODS A systematic review and meta-analysis were performed by searching eligible studies published before January 24, 2019 on PubMed, EMBASE, and Web of Science databases. The primary outcomes were 3-year and 5-year graft survival. Incidence of small-for-size syndrome and short term mortality were also extracted. RESULTS This meta-analysis is reported according to the guidelines of the PRISMA 2009 Statement. Seven retrospective observational studies with a total of 1821 LDLT recipients were included in the meta-analysis. SFSG is associated with significantly poorer medium-term graft survival. The pooled odds ratio for 3-year graft survival was 1.58 [95% confidence interval 1.10-2.29, P = 0.014]. On the other hand, pooled results of the studies showed that SFSG had no significant discriminatory effect on 5-year graft survival with an odds ratio of 1.31 (95% confidence interval 0.87-1.97, P = 0.199). Furthermore, incidence of small-for-size syndrome detected in recipients of SFSG ranged from 0-11.4% in the included studies. CONCLUSION SFSG is associated with inferior medium-term but not long-term graft survival. Comparable long-term graft survival based on liver graft size shows that smaller grafts could be accepted for LDLT with appropriate flow modulatory measures. Close follow-up for graft function is warranted within 3 years after liver transplantation.

关键词： Living donor liver transplantation Small-for-size grafts Small-for-size syndrome Graft survival

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Long-term impacts of graphene oxide and Ag nanoparticles on anammox process: Performance, microbial community and toxic mechanism

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Journal of Environmental Sciences 2019年第5期31卷 239-247页

作者： Huai Li Zifang chi Baixing yan Key Laboratory of Wetland Ecology and Environment Northeast Institute of Geography and Agroecology Chinese Academy of Sciences Key Laboratory of Groundwater Resources and Environment Ministry of Education Jilin University

The increasing application of engineered nanoparticles(NPs) has posed an emerging challenge to constructed wetland wastewater treatment. The performance, microbial community and toxic mechanism of anammox-based unplanted subsurface-flow constructed wetlands(USFCWs) were investigated under the long-term exposure of different graphene oxides(GOs) and Ag NP concentrations. Results showed that the addition of GO could promote TN removal, manifesting as function anammox bacteria C. Anammoxoglobus having a relative high abundance, for GO did not cause significant damage to the cell integrity though there was an increase in ROS concentrations. TN removal would not be obviously affected under exposure of 1 mg/L Ag NPs, for the function gene related to cell biogenesis and repair was up-regulated; while the addition of 10 mg/L Ag NPs would have an inhibiting effect on TN removal in the USFCWs, for the disappearance of some species having anammox ability. Key enzymes of anammox process(NIR and HDH) decreased to some extent under GO and Ag NP exposure, and function gene of defense mechanisms had an increase trend in samples.

关键词： Anammox Ag NPs GO Microbial community Function gene Key enzymes

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