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Minimally invasive donor hepatectomy, are we ready for prime time?

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World Journal of Gastroenterology 2018年第25期24卷 2698-2709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

Minimally invasive surgery potentially reduces operative morbidities. However, pure laparoscopic approaches to donor hepatectomy have been limited by technical complexity and concerns over donor safety. Reducedwound donor hepatectomy, either in the form of a laparoscopic-assisted technique or by utilizing a minilaparotomy wound, i.e., hybrid approach, has been developed to bridge the transition to pure laparoscopic donor hepatectomy, offering some advantages of minimally invasive surgery. To date, pure laparoscopic donor left lateral sectionectomy has been validated for its safety and advantages and has become the standard in experienced centres. Pure laparoscopic approaches to major left and right liver donation have been reported for their technical feasibility in expert hands. Robotic-assisted donor hepatectomy also appears to be a valuable alternative to pure laparoscopic donor hepatectomy, providing additional ergonomic advantages to the surgeon. Existing reports derive from centres with tremendous experience in both laparoscopic hepatectomy and donor hepatectomy. The complexity of these procedures means an arduous transition from technical feasibility to reproducibility. Donor safety is paramount in living donor liver transplantation. Careful donor selection and adopting standardized techniques allow experienced transplant surgeons to safely accumulate experience and acquire proficiency. An international prospective registry will advance the understanding for the role and safety of pure laparoscopic donor hepatectomy.

关键词： laparoscopic donor hepatectomy living donor liver transplantation minimally invasive surgery

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

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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

Surgical cystogastrostomy: Is it still worthwhile?

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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

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

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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

Immunotherapy after liver transplantation:Where are we now?

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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

Hepatectomy bridges to transplant—the road to cure?

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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

Clinicopathological survey of 23 patients with lacrimal fossa lesions in Hong Kong

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International Journal of Ophthalmology(English edition) 2011年第3期4卷 311-313页

作者： Danny siu-Chun Ng Edwin Chan kin Yau Clement Wai-Nang Chan Department of Ophthalmology Tung Wah Eastern Hospital

AIM: To survey the clinicopathological correlations of lacrimal fossa lesions in the Hong Kong population. METHODS: A total of 23 patients with lacrimal fossa lesions were identified radiologically. The mean age at the time of diagnosis was 52 year-old. The medical records of patients diagnosed with lacrimal fossa lesions and subsequently underwent radiological investigations were collected and reviewed retrospectively throughout a six years period from 2000 to 2006 from three regional hospitals (Tung Wah Eastern Hospital, Pamela Youde Nethersole Eastern Hospital and Queen Mary Hospital) belonging to the Hong Kong Mega Cluster. Patient demographics, presenting signs and symptoms, imaging modalities, pathological reports and subsequent management were recorded. RESULTS: The most common initial presenting symptom was upper lid swelling (83%) followed by proptosis (13%). 19 patients (83%) had benign lacrimal fossa lesion and 4 patients (17%) had malignancy. Three of the malignancies were lymphomas and one was adenoid cystic carcinoma. CONCLUSION: Age is an important factor in considering the differential diagnosis of lacrimal fossa lesion. Lymphoproliferative diseases have the highest incidence in patients over 60 years of age while inflammatory lesions are more common in younger patients in Hong Kong.

关键词： lacrimal gland tumor lymphoma

Suppression of innate antiviral response by severe acute respiratory syndrome coronavirus M protein is mediated through the first transmembrane domain

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Cellular & Molecular Immunology 2014年第2期11卷 141-149页

作者： Kam-Leung siu Chi-Ping Chan kin-Hang Kok Patrick Chiu-Yat Woo Dong-Yan Jin Department of Biochemistry The University of Hong Kong Pokfulam Hong Kong Department of Microbiology The University of Hong KongPokfulam Hong Kong

Coronaviruses have developed various measures to evade innate immunity, We have previously shown that severe acute respiratory syndrome （SARS） coronavirus M protein suppresses type I interferon （IFN） production by impeding the formation of functional TRAF3-containing complex. In this study, we demonstrate that the IFN-antagonizing activity is specific to SARS coronavirus M protein and is mediated through its first transmembrane domain （TM 1） located at the N terminus. M protein from human coronavirus HKU 1 does not inhibit IFN production. Whereas N-linked glycosylation of SARS coronavirus M protein has no influence on IFN antagonism, TM1 is indispensable for the suppression of IFN production. TM 1 targets SARS coronavirus M protein and heterologous proteins to the Golgi apparatus, yet Golgi localization is required but not sufficient for IFN antagonism. Mechanistically, TM 1 is capable of binding with RIG-I, TRAF3, TBK1 and IKK~, and preventing the interaction of TRAF3 with its downstream effectors. Our work defines the molecular architecture of SARS coronavirus M orotein reouired for suooression of innate antiviral re^nnn^e.

关键词： human coronavirus HKU1 innate antiviral response SARS coronavirus TRAF3 type I interferons

Acquisition repeatability of MRI radiomics features in the head and neck:a dual-3D-sequence multi-scan study

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Visual Computing for Industry,Biomedicine,and Art 2022年第1期5卷 115-127页

作者： Cindy Xue Jing Yuan Yihang Zhou Oi Lei Wong kin Yin Cheung siu Ki Yu Research Department Hong Kong Sanatorium&HospitalHong KongChina Medical Physics Department Hong Kong Sanatorium&HospitalHong KongChina

Radiomics has increasingly been investigated as a potential biomarker in quantitative imaging to facilitate personalized diagnosis and treatment of head and neck cancer(HNC),a group of malignancies associated with high ***,the feature reliability of radiomics is a major obstacle to its broad validity and generality in application to the highly heterogeneous head and neck(HN)*** particular,feature repeatability of radiomics in magnetic resonance imaging(MRI)acquisition,which is considered a crucial confounding factor of radiomics feature reliability,is still sparsely *** study prospectively investigated the acquisition repeatability of 93 MRI radiomics features in ten HN tissues of 15 healthy volunteers,aiming for potential magnetic resonance-guided radiotherapy(MRgRT)treatment of *** subject underwent four MRI acquisitions with MRgRT treatment position and immobilization using two pulse sequences of 3D T1-weighed turbo spin-echo and 3D T2-weighed turbo spin-echo on a 1.5T MRI *** repeatability of radiomics feature acquisition was evaluated in terms of the intraclass correlation coefficient(ICC),whereas within-subject acquisition variability was evaluated in terms of the coefficient of variation(CV).The results showed that MRI radiomics features exhibited heterogeneous acquisition variability and uncertainty dependent on feature types,tissues,and pulse *** a small fraction of features showed excellent acquisition repeatability(ICC>0.9)and low within-subject *** MRI scans improved the accuracy and confidence of the identification of reliable features concerning MRI acquisition compared to simple test-retest repeated *** study contributes to the literature on the reliability of radiomics features with respect to MRI acquisition and the selection of reliable radiomics features for use in modeling in future HNC MRgRT applications.

关键词： Radiomics Magnetic resonance guided radiotherapy Head and neck Repeatability Intraclass correlation coefficient