检索结果-南通市图书馆

Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2018年第45期24卷 5081-5094页

作者： Kin Pan Au kenneth siu ho chok Department of Surgery Queen Mary Hospital Department of Surgery and State Key Laboratory for Liver Research The University of Hong Kong

A large number of liver transplants have been performed for hepatocellular carcinoma(HCC), and recurrence is increasingly encountered. The recurrence of HCC after liver transplantation is notoriously difficult to manage. We hereby propose multi-disciplinary management with a systematic approach. The patient is jointly managed by the transplant surgeon, physician, oncologist and radiologist. Immunosuppressants should be tapered to the lowest effective dose to protect against rejection. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor could be considered with close monitoring of graft function and toxicity. Comprehensive staging can be performed by dual-tracer positron emission tomography-computed tomography or the combination of contrast computed tomography and a bone scan. In patients with disseminated recurrence, sorafenib confers survival benefits but is associated with significant drug toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic recurrence can be managed with graft resection, but significant operative morbidity is expected. Radiofrequency ablation and stereotactic body radiation therapy(SBRT) are effective alternative strategies. In patients with more advanced hepatic disease, regional treatment with trans-arterial chemoembolization or intra-arterial Yttrium-90 can be considered. For patients with extra-hepatic oligorecurrence, loco-regional treatment can be considered if practical. Patients with more than one site of recurrence are not always contraindicated for curative treatments. Surgical resection is effective for patients with pulmonary oligo-recurrence, but adequate lung function is a prerequisite. SBRT is a non-invasive and effective modality that conveys local control to pulmonary and skeletal oligo-recurrences.

关键词： Hepatocellular carcinoma Recurrence Liver transplantation

Sarcopenia in pancreatic cancer–effects on surgical outcomes and chemotherapy

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Oncology 2019年第7期11卷 527-537页

作者： Miu Yee Chan kenneth siu ho chok Department of Surgery Queen Mary Hospital 102 Pokfulam Road Hong Kong China Department of Surgery and State Key Laboratory for Liver Research The University of Hong Kong Hong Kong China

Sarcopenia is found in up to 65% of pancreatic cancer patients. The definition and diagnostic methods for sarcopenia have changed over the years, and the measurement of skeletal muscle mass with cross-sectional imaging has become the most popular way of assessment, although the parameters measured vary among different studies. It is still debatable that there is an association between sarcopenia and postoperative pancreatic fistula, but most studies showed a higher risk in patients with sarcopenic obesity. Long-term survival is worse in sarcopenic patients, as shown by meta-analysis. Sarcopenia is also associated with decreased survival and higher toxicity in patients receiving chemotherapy, and chemotherapy also tends to potentiate sarcopenia. Treatment for sarcopenia still remains an area for research, although oral supplements, nutritional modifications and exercise training have been shown to improve sarcopenia.

关键词： Sarcopenia Pancreatic cancer Clinical outcomes Surgical outcomes Chemotherapy Radiotherapy

Surgical cystogastrostomy: Is it still worthwhile?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2024年第17期30卷 2298-2301页

作者： Kin Pan Au kenneth siu ho chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong Kong 999077China Department of Surgery The Chinese University of Hong KongHong Kong 999077China

The article by Ker et al explores the treatment of peripancreatic fluid collection(PFC).The use of percutaneous drainage,endoscopy,and surgery for managing PFC are *** drainage is noted for its low risk profile,while endoscopic cystogastrostomy is more effective due to the wider orifice of the metallic *** cystogastrostomy is a definitive treatment with a reduced need for reintervention,especially for cases with extensive collections and significant *** choice of treatment modality should be tailored to individual patient characteristics and disease factors,considering the expertise available.

关键词： Endoscopic cystgastrostomy Surgical cystgastrostomy Pancreatitis Pancreatic necrosis Peripancreatic collection

Is the treatment outcome of hepatocellular carcinoma inferior in elderly patients?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2019年第27期25卷 3563-3571页

作者： Kevin Ka Wan Chu kenneth siu ho chok Department of Surgery Queen Mary HospitalHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

In view of the increasing life expectancy in different parts of the world, a larger proportion of elderly patients with hepatocellular carcinoma(HCC) requiring oncological treatment is expected. The clinicopathological characteristics of HCC in elderly patients and in younger patients are different. Elderly patients, in general, also have more comorbidities. Evaluation of the efficacy of different HCC treatment options in elderly patients is necessary to optimize treatment outcomes for them. Treatment modalities for HCC include hepatectomy, liver transplantation, radiofrequency ablation, transarterial chemoembolization, and molecular-targeted therapy with sorafenib. In this review, current evidence on the risks and outcomes of the different HCC treatments for elderly patients are discussed. According to data in the literature, elderly patients and younger patients benefited similarly from HCC treatments. More clinical data are needed for the determination of selecting criteria on elderly HCC patients to maximize their chance of getting the most appropriate and effective treatments. As such,further studies evaluating the outcomes of different HCC treatment modalities in elderly patients are warranted.

关键词： Hepatocellular carcinoma Aged Clinical outcome Surgery Hepatectomy

Immunotherapy after liver transplantation:Where are we now?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Surgery 2021年第10期13卷 1267-1278页

作者： Kin Pan Au kenneth siu ho chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

BACKGROUND There is limited evidence on the safety of immunotherapy use after liver transplantation and its efficacy in treating post-liver transplant hepatocellular carcinoma(HCC)*** To assess the safety of immunotherapy after liver transplant and its efficacy in treating post-liver transplant HCC *** A literature review was performed to identify patients with prior liver transplantation and subsequent *** reviewed the rejection rate and risk factors of *** patients treated for HCC,the oncological outcomes were evaluated including objective response rate,progression-free survival(PFS),and overall survival(OS).RESULTS We identified 25 patients from 16 publications and 3 patients from our institutional database(total n=28).The rejection rate was 32%(n=9).Early mortality occurred in 21%(n=6)and was mostly related to acute rejection(18%,n=5).Patients who developed acute rejection were given immunotherapy earlier after transplantation(median 2.9 years vs 5.3 years,P=0.02)and their graft biopsies might be more frequently programmed death ligand-1-positive(100%vs 33%,P=0.053).Their PFS(1.0±0.1 mo vs 3.5±1.1 mo,P=0.02)and OS(1.0±0.1 mo vs 19.2±5.5 mo,P=0.001)compared inferiorly to patients without *** the 19 patients treated for HCC,the rejection rate was 32%(n=6)and the overall objective response rate was 11%.The median PFS and OS were 2.5±1.0 mo and 7.3±2.7 mo after *** Rejection risk is the major obstacle to immunotherapy use in liver transplant *** studies on the potential risk factors of rejection are warranted.

关键词： Liver transplant Hepatocellular carcinoma Recurrence Immunotherapy Rejection Survival

Mammalian target of rapamycin inhibitors after post-transplant hepatocellular carcinoma recurrence:Is it too late?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Surgery 2020年第4期12卷 149-158页

作者： Kin Pan Au kenneth siu ho chok Department of Surgery Queen Mary HospitalHong Kong 999077China Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong Kong 999077China

BACKGROUND Mammalian target of rapamycin(mTOR)inhibitors have been shown to reduce the risk of tumour recurrence after liver transplantation for hepatocellular carcinoma(HCC).however,their role in established post-transplant HCC recurrence is *** To investigate whether mTOR inhibitor offers a survival benefit in posttransplant HCC *** A retrospective study of 143 patients who developed HCC recurrence after liver transplantation was *** were divided into 2 groups based on whether they had received mTOR inhibitor-based *** primary endpoint was post-recurrence *** Seventy-nine(55%)patients received an mTOR inhibitor-based immunosuppressive regime,while 64(45%)patients did *** mTOR inhibitor group had a lower number of recurrent tumours(2 vs 5,P=0.02)and received more active treatments including radiotherapy(39 vs 22%,P=0.03)and targeted therapy(59 vs 23%,P<0.001).The median post-recurrence survival was 21.0±4.1 mo in the mTOR inhibitor group and 11.2±2.5 mo in the control *** Cox regression analysis confirmed that mTOR inhibitor therapy was independently associated with improved post-recurrence survival(P=0.04,OR=0.482,95%CI:0.241-0.966).The number of recurrent tumours and use of other treatment modalities did not affect *** survival difference was observed between mTOR inhibitor monotherapy and combination therapy with calcineurin *** mTOR inhibitors prolonged survival after post-transplant HCC recurrence.

关键词： Mammalian target of rapamycin inhibitor Hepatocellular carcinoma Recurrence Liver transplant Survival Outcomes

Hepatectomy bridges to transplant—the road to cure?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Hepatobiliary Surgery and Nutrition 2019年第1期8卷 72-73页

作者： Kin Pan Au kenneth siu ho chok Department of Surgery The University of Hong KongHong KongChina

Liver transplantation and hepatic resection are effective surgical strategies for hepatocellular carcinoma(HCC).In the current issue of Annals of Surgery,Professor Pinna and colleagues applied a cure model to compare both treatments(1).Comparison was made in terms of cure ***,curation has never been concisely defined in clinical *** the standard survival model,patients are considered disease-free after R0 resection but are always at risk of *** is arguable,particularly for HCC,whether disease clearance equates curation,as more than half of patients recur in 5 years after radical resection(2).In epidemiology,statistical cure is achieved when the mortality of the patients treated for a specific disease return to that in the general population(3).however,statistical cure is neither practical in clinical sense,as patients surviving with disease are also considered cured.

关键词： Surgery epidemiology mortality

Importance of surgical margin in the outcomes of hepatocholangiocarcinoma

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Hepatology 2017年第13期9卷 635-641页

作者： Ka Wing Ma kenneth siu ho chok Department of Surgery Queen Mary Hospital Department of Surgery and State Key Laboratory for Liver Research the University of Hong Kong

AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METhoDS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from1995 to 2014 were *** with pathologically confirmed HCC-CC were included for ***,biochemical,operative and pathological data were analyzed against survival outcomes. RESULTSForty-two patients were included for *** median age was 53.5 *** were 29 *** B virus was identified in 73.8%of the *** patients had preserved liver *** median preoperative indocyanine green retention rate at 15 min was 10.2%.The median tumor size was 6.5 *** hepatectomy was required in over 70%of the *** was performed in 6 *** hospital death *** median hospital stay was 13 *** median follow-up period was 32 *** 5-year disease-free survival and overall survival were 23.6%and 35.4%*** was the only independent factor associated with diseasefree survival[P<0.001,odds ratio 4,95%confidence interval(CI):1.9-8.0].In patients with multifocal tumor(n=20),resection margin of≥1 cm was associated with improved 1-year disease-free survival(40%vs 0%;log-rank,P=0.012).CONCLUSIONHCC-CC is a rare disease with poor *** margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.

关键词： Hepatocholangiocarcinoma Hepatocellular cholangiocarcinoma Survival Hepatectomy Resection margin

Colorectal liver metastases:An update on multidisciplinary approach

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Hepatology 2019年第2期11卷 150-172页

作者： Felix Che-Lok Chow kenneth siu-ho chok Department of Surgery Queen Mary Hospital Department of Surgery and State Key Laboratory for Liver Research the University of Hong Kong

Liver metastasis is the commonest form of distant metastasis in colorectal *** criteria for surgery and liver-directed therapies have recently been ***,resectability remains poorly *** biology is increasingly recognized as an important prognostic factor;hence molecular profiling has a growing role in risk stratification and management *** resection is the only treatment modality for curative *** most appropriate surgical approach is yet to be *** primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach;these two strategies have comparable long-term *** patients with a limited future liver remnant,portal vein embolization,combined ablation and resection,and associating liver partition and portal vein ligation for staged hepatectomy have been advocated,and each has their pros and *** role of neoadjuvant and adjuvant chemotherapy is still *** biological agents and loco-regional therapies(thermal ablation,intra-arterial chemo-or radio-embolization,and stereotactic radiotherapy) further improve the already favourable *** recent debate about offering liver transplantation to highly selected patients needs validation from large clinical *** protocols are missing,and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.

关键词： Colorectal cancer Liver metastases Hepatic resection Neoadjuvant therapy Adjuvant chemotherapy Intra-arterial therapy Precision medicine Multidisciplinary approach