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Frontiers of Medicine 2013年第4期7卷 520-522页

作者： eric c.h.lai Department of Surgery Pamela Youde Nethersole Eastern HospitalChai WanHong KongChina

I read with great interest the consensus and guideline of laparoscopic hepatectomy,which was originated from the experts in china[1].This is a significant step forward in minimally invasive liver *** development of minimally invasive liver surgery over the last 2 decades has a great impact on the surgical practice in china,and the other parts of the *** potential advantages of laparoscopic hepatectomy are those of minimal access surgery(Table 1).

关键词： Surgery hepatectomy surgery

Development and controversies of adjuvant therapy for pancreatic cancer

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hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 121-125页

作者： Wan-Yee Lau eric c.h.lai Faculty of Medicine the Chinese University of Hong Kong Prince of Wales Hospital Shatin New TerritoriesHong Kong SAR China

BAcKGROUND: Pancreatic cancer is an aggressive malignancy with a dismal prognosis. Radical surgery provides the only chance for a cure with a 5-year survival rate of 7%-25%. An effective adjuvant therapy is urgently needed to improve the surgical outcome. This review describes the current status of adjuvant therapy for pancreatic cancer, and highlights its controversies. DATA SOURcES: A Medline database search was performed to identify relevant articles using the keywords 'pancreatic neoplasm', and 'adjuvant therapy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Eight prospective randomized controlled trials (RcTs) on the use of adjuvant chemotherapy and chemoradiation for pancreatic cancer could be identified. The results for adjuvant regimens based on systemic 5-fluorouracil with or without external radiotherapy were conflicting. The recent two RcTs on gemcitabine based regimen gave promising results. cONcLUSIONS: Based on the available data, no standard adjuvant therapy for pancreatic cancer can be established yet. The best adjuvant regimen remains to be determined in large-scale RcTs. Future trials should use a gemcitabine based regimen.

关键词： pancreatic neoplasm pancreatectomy adjuvant therapy radiotherapy chemotherapy

classification of iatrogenic bile duct injury

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hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 459-463页

作者： Wan-Yee Lau eric c.h.lai Department of Surgery the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BAcKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURcES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. however, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. cONcLUSIONS: None of the classification system is universally accepted as each has its own limitation. hopefully, a universally accepted comprehensive classification system will be published in the near future.

关键词： laparoscopic cholecystectomy bile duct injury bile duct stricture bile leak classification

Methods of vascular control technique during liver resection:a comprehensive review

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hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 473-481页

作者： Wan-Yee Lau eric c.h.lai Stephanie h.Y.Lau Faculty of Medicine the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BAcKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURcES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RcT) and 5 RcTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RcTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RcT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RcTs evaluated the use of hemihepatic vascular occlusion. One RcT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RcT showed it had significantly less liver ischemic injury. No RcT had been carried out to assess segmental vascular occlusion. Two RcTs compared the outcomes of total hepatic vascular exclusion (ThVE) and Pringle maneuver. One RcT showed ThVE resulted in similar blood loss, but a higher postoperative complication. The other RcT showed less blood loss using ThVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RcT showed that selective hepatic vascular exclusion (ShVE) had

关键词： vascular control vascular exclusion hepatectomy liver neoplasm Pringle maneuver

The current role of neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hepatocellular carcinoma:a systematic review

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hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 124-133页

作者： Wan-Yee Lau eric c.h.lai Stephanie h.Y.Lau State Key Laboratory for Diagnosis and Treatment of Infectious Diseases First Affiliated HospitalZhejiang University School of Medicine

BAcKGROUND: Following curative treatment for hepatocellular carcinoma (hcc), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any neoadjuvant or adjuvant therapy, which can decrease or delay the incidence of intra-hepatic recurrence, or any cancer chemoprevention which can prevent a new hcc from developing in the liver remnant, will improve the results of liver resection. This article systematically reviewed the current evidence of neoadjuvant, adjuvant, and chemoprevention in partial hepatectomy of hcc. DATA SOURcES: Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'adjuvant therapy', 'neoadjuvant therapy', and 'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with (131)I-lipiodol and adjuvant systemic interferon showed promising results. however, there were only a limited number of such studies. cONcLUSIONS: Further randomized controlled studies need to be carried out. currently, there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hcc.

关键词： hepatocellular carcinoma hepatectomy adjuvant therapy neoadjuvant therapy therapeutic embolization

Loco-regional intervention for hepatocellular carcinoma

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Journal of Interventional Medicine 2019年第2期2卷 43-46页

作者： Wan Yee Lau eric c.h.lai Faculty of Medicine The Chinese University of Hong KongNew TerritoriesHong KongChina

Anatomic location/size and number of lesions,inadequate volume of future liver remnant,or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma(hcc).Liver transplantation can cure some patients with poor liver function,but few patients are eligible because of scarcity of *** specific anti-cancer treatment,the prognosis of hcc is *** locoregional therapies are used to treat patients who are not candidates for surgery,and have emerged as tools for palliation,tumor downstaging,and bridging therapy prior to liver ***,local ablative therapy even competes with partial hepatectomy and liver transplantation as a primary treatment for small *** is well suited to treatment with loco-regional therapy because it has a tendency to stay within the liver,with distant metastasis generally occurring late in the course of *** suggests that an effective local-regional therapy can have a great impact on hcc patients who are not candidates for surgical ***-regional therapy can further be justified because patients with hcc usually die of liver failure consequent to intrahepatic growth resulting in liver tissue destruction,rather than extrahepatic metastases.

关键词： hepatocellular carcinoma hepatectomy Loco-regional therapy TAcE Local ablation

Robotic hepatectomy for hepatocellular carcinoma: a clinical review

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hepatoma Research 2017年第11期3卷 278-283页

作者： eric c.h.lai Daniel T.M.chung Oliver c.Y.chan chung Ngai Tang Department of Surgery Pamela Youde Nethersole Eastern HospitalChai WanHong KongChina

The robotic surgical system was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed at reviewing robotic partial hepatectomy to conventional laparoscopic or open partial hepatectomy in terms of perioperative, oncologic, and healthcare costs for hepatocellular carcinoma (hcc). Studies were identified by searching MEDLINE and PubMed databases for articles from January 2004 to June 2017 using the keywords 'laparoscopic hepatectomy', 'robotic surgery','robotic hepatectomy', and 'hepatocellular carcinoma'. case reports were not included. The open conversion rate, overall morbidity rate, and mortality rate of robotic partial hepatectomy were reported as 0-14.3%, 0-27%, and 0-3%, respectively. Although little data regarding robotic approach for hcc have been reported, it appears to be better than open approach, particularly blood loss and hospital stay, and similar to conventional laparoscopic approach in terms of short term outcomes. The oncological outcomes were comparable to open or laparoscopic approach. Well-known advantages of the robotic system allow resection of tumor location over posterior and superior segments or major hepatectomy with more ease. The main disadvantage of robotic approach was its high cost. In conclusion, oncological data from homogenous series of hcc after robotic partial hepatectomy was needed. Robotic approach was safe to be an alternative option of *** that it can provide over open or conventional laparoscopy approach.

关键词： Laparoscopy hepatectomy robotic surgery hepatocellular carcinoma

Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy： a comparative study for short-term outcomes

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Frontiers of Medicine 2015年第3期9卷 356-360页

作者： eric c. h. lai chung Ngai Tang Department of Surgery Pamela Youde Nethersole Eastern Hospital Chai Wan Hong Kong SAR China

Robotic system has been increasingly used in pancreatectomy. however, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group （221.4 min） was significantly longer than that in the laparoscopic group （173.6 min）（P = 0.026）. Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate （52.9% vs. 38.9%）（P = 0.505）, operative blood loss （100.3 ml vs. 268.3 ml）（P = 0.29）, overall morbidity rate （47.1% vs. 38.9%）（P = 0.73）, and post-operative hospital stay （11.4 days vs. 14.2 days）（P = 0.46）. Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. however, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

关键词： distal pancreatectomy pancreatic neoplasm robotic surgery

hepatocellular carcinoma: current management and recent advances

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hepatobiliary & Pancreatic Diseases International 2008年第3期7卷 237-257页

作者： Wan-Yee Lau eric c. h. lai Faculty of Medicine The Chinese University of Hong Kong Prince of Wales Hospital Shatin New Territories Hong Kong SAR China

BAcKGROUND: hepatocellular carcinoma (hcc) is a major health problem worldwide. It is the fifth most common cancer in the world, and the third most common cause of cancer-related death. Without specific treatment, the prognosis is very poor. The goal of management is 'cancer control'-a reduction in its incidence and mortality as well as an improvement in the quality of life of patients with hcc and their families. This article aims to review the current management of hcc and its recent advances. DATA SOURcES: A MEDLINE database search was performed to identify relevant article using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'liver transplantation', and 'local ablative therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Liver resection and liver transplantation remain the options that give the best chance of a cure. Recent evidence suggests that local ablative therapy may offer comparable survival results in patients with small hcc, and preserved liver function. Transarterial chemoembolization (TAcE) is the most promising palliative modality for unresectable hcc, but other techniques, such as transarterial radioembolization (TARE), and local ablative therapy, have also shown comparable results. cONcLUSIONS: Early diagnosis of hcc remains a key goal in improving the prognosis of patients. During the last two decades, operative mortality and surgical outcome of liver resection and liver transplantation for hcc have improved. Progress also has been made in multi-modality therapy which can increase the chance of survival and improve the quality of life for patients with advanced hcc.

关键词： hepatocellular carcinoma hepatectomy liver transplantation local ablative therapy

A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum

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Frontiers of Medicine 2015年第1期9卷 108-111页

作者： eric c.h. lai Kam Man chung Stephanie h.Y. Lau Wan Yee Lau Faculty of Medicine The Chinese University of Hong Kong Shatin Hong Kong SAR China Dr. K.M. chung's clinic Rm 807 Hang Seng Tsimshatsui Building 18 Carnarvon Road Tsimshatsui Hong Kong SAR China Department of Surgery Pamela Youde Nethersole Eastern Hospital Hong Kong SAR China Department of Surgery Queen Elizabeth Hospital Hong Kong SAR China

hemoperitoneum is a rare and potentially life-threatening complication of GIST. We reported a 54- year-old man who developed disseminated intra-abdominal recurrence from a previously resected gastrointestinal stromal tumour （GIST） of the small bowel, and the patient presented with hemoperitoneum. Emergent debulking surgery was performed. A high dose imatinib was prescribed. Despite the presence of residual disease, the patient was well clinically 8 months after the operation. Even though, there is no evidence to support the routine use of debulking surgery in the management of GIST. In our patient, disease progression after second line targeted therapy and the absence of alternative treatment options for spontaneous rupture and hemoperitoneum prompted us to treat the patient aggressively. Resection of the ruptured GIST was carried out for control of bleeding and to prevent recurrent bleeding in this patient with good surgical risks. During the treatment decision-making, the patient＇s general condition, the risk of surgery and the extent of dissemination were taken into consideration. In this patient who presented with spontaneous rupture of a small intestinal GIST, the novel use of targeted therapy and aggressive surgical treatment produced reasonably good survival outcome.

关键词： gastrointestinal stromal tumour hemoperitoneum small bowel GIST small bowel neoplasm imatinib