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Survival analysis of breast cancer liver metastasis treated by hepatectomy: A propensity score analysis for Chinese women in Hong Kong

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Hepatobiliary & Pancreatic Diseases International 2019年第5期18卷 452-457页

作者： Tan To Cheung Kenneth SH Chok Albert CY Chan simon hy tsang Wing Chiu Dai Thomas CC Yau Ava Kwong Chung Mau Lo Department of Surgery Queen Mary HospitalThe University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Medicine Queen Mary HospitalThe University of Hong Kong102 Pok Fu Lam RoadHong KongChina

Background: Survival of patients with breast cancer liver metastasis is very poor. This study aimed to analyze the survival outcome of hepatectomy for this patient population. Methods: From January 1995 to December 2014, 2522 patients with liver cancer received hepatectomy at our hospital. Twenty-one of them, all female, received the operation for breast cancer liver metastasis. Performance was compared with patients with colorectal liver metastasis treated with hepatectomy after propensity score analysis in a ratio of 1:3. Results: Twenty-one patients received hepatectomy for breast cancer. After propensity score matching, 63 patients who had hepatectomy for colorectal cancer were selected for comparison. There was no significant difference in immediate or short-term outcomes between the two groups of patients in terms of operative time, blood loss and surgical morbidities. All patients with breast cancer had R0 resection. No hospital death occurred. After hepatectomy, the 1-, 3- and 5-year overall survival rates were 100.0%, 58.9% and 58.9% respectively in patients with breast cancer. The 1-, 3- and 5-year overall survival rates were 95.0%, 57.2% and 39.7% respectively in patients with colorectal cancer (P = 0.572). On multivariate analysis, triple negative status was the only independent poor prognostic factor in breast cancer liver metastasis (OR = 6.411;95% CI: 1.351–30.435;P = 0.019). Conclusions: Hepatectomy is a safe and effective way of treating breast cancer liver metastasis at experienced centers where multidisciplinary adjuvant treatments are available. It can be considered more frequently as part of the multidisciplinary care for this patient population.

关键词： Liver cancer Breast cancer Hepatectomy Metastases

Samaritan donor interchange in living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 105-109页

作者： See Ching Chan Kenneth SH Chok William W Sharr Albert CY Chan simon hy tsang Wing Chiu Dai Chung Mau Lo State Key Laboratory for Liver Research The University of Hong Kong Department of Surgery The University of Hong Kong

BACKGROUND: In order to overcome ABO blood group incompatibility, paired donor interchange has been practised in living donor liver transplantation. Liver transplantations using grafts donated by Samaritan living donors have been performed in Europe, North America, South Korea, and Hong Kong. Such practice is clearly on strong biological grounds although social and psychological implications could be far-reaching. Local experience has been satisfactory but is still limited. As few centers have this arrangement, its safety and viability are still being assessed under a clinical trial setting. METHODS: Here we report a donor interchange involving an ABO-compatible pair with a universal donor and an ABOincompatible pair with a universal recipient. This matching was not only a variation but also an extension of the donor interchange scheme. RESULTS: The four operations(two donor hepatectomies and two recipient operations) were successful. All the two donors and the two recipients recovered well. Such donor interchange further supports the altruistic principle of organ donation in contrast to exchange for a gain. CONCLUSIONS: Samaritan donor interchange certainly taxes further the ethical challenge of donor interchange. Although this practice has obvious biological advantages, such advantages have to be weighed against the potential increase in potential psychological risks to the subjects in the interchange. Further ethical and clinical evaluations of local and overseas experiences of donor interchange should guide future clinical practice in utilizing this potential organ source for transplantation.

关键词： orthotopic liver transplantation living donor liver transplantation right lobe

Modulation of graft vascular inflow guided by flowmetry and manometry in liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2011年第6期10卷 649-656页

作者： See Ching Chan Chung Mau Lo Kenneth SH Chok William W Sharr Tan To Cheung simon hy tsang Albert CY Chan Sheung Tat Fan Department of Surgery The University of Hong Kong 102 Pokfulam RoadHong KongChina State Key Laboratory for Liver Research The University of Hong Kong 102 Pokfulam RoadHong KongChina

BACKGROUND:Survival of the partial graft after living donor liver transplantation owes much to its tremendous regenerative *** excellent venous outflow capacity,a graft within a wide range of graft-to-standard-liver-volume ratios can cope with portal hypertension that is common in liver transplant ***,when the ratio range is exceeded,modulation of graft vascular inflow becomes necessary for graft *** interplay between graft-to-standard-liver-volume ratio and portal pressure,in the presence of portosystemic shunt or otherwise,requires individualized modulation of graft portal and arterial *** of portal inflow by shunt ligation can be guided by transonic flowmetry,whereas muting of portal inflow by splenic artery ligation can be monitored by portal electronic ***:We describe four cases to illustrate the ***:One patient had hepatic artery thrombosis resulting from splenic artery steal syndrome which was the sequela of small-for-size *** splenic artery ligation and re-anastomosis of the hepatic artery successfully muted the portal inflow and boosted the hepatic arterial *** patient with portal vein thrombosis underwent *** inflow was boosted with ligation of portosystemic shunt,which is often present in these patients with portal *** coexistence of splenic aneurysm and splenorenal shunt required ligation of both in the third *** fourth patient,with portal pressure and flow monitoring,avoided ligation of a coronary vein which became a main portal inflow after portal ***:Management of graft inflow modulation guided selectively by transonic flowmetry or portal manometry was described.

关键词： graft inflow liver transplantation modulation

The impact of family history of hepatocellular carcinoma on its patients' survival

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Hepatobiliary & Pancreatic Diseases International 2012年第2期11卷 160-164页

作者： Wing Chiu Dai Sheung Tat Fan Tan To Cheung Kenneth SH Chok Albert CY Chan simon hy tsang Ronnie TP Poon Chung Mau Lo Department of Surgery The University of Hong Kong 102 Pokfulam Road Hong Kong China State Key Laboratory for Liver Research The University of Hong Kong 102 Pokfulam Road Hong Kong China

BACKGROUND:Family history of hepatocellular carcinoma(HCC) has been identified as a risk factor for the development of the *** aim of this study is to evaluate the impact of such a history on HCC patients’ ***:Data of all HCC patients(n=4532) managed at our center from 1989 to 2008 were prospectively *** patients were quizzed on their various characteristics including family HCC ***:Totally 475(10.48%) patients had a family history of *** presented the disease at a significantly earlier age(median 53 vs 59 years,P<0.0001) and at an earlier stage(the United Network for Organ Sharing staging system).They had significantly better liver function in terms of ChildPugh classification and serum albumin and bilirubin *** more of them presented the disease without symptoms(44.0% vs 29.4%,P<0.0001).They also had significantly better overall survival under these specifications:patients in the whole study cohort,patients who had minor hepatectomy,patients with stage I disease,patients with stage II disease,and patients with stage III ***:Contrary to what is generally believed,we found in this study cohort that patients with a family history of HCC had better overall survival than those without such a *** believe this was in part due to earlier diagnosis of the disease and better liver function in this group of ***,the effects of genetic factors on the risk of HCC cannot be overlooked and are yet to be identified.

关键词： hepatocellular carcinoma family history resection survival risk factor

Retrohepatic vena cava deroofing in living donor liver transplantation for caudate hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 552-555页

作者： See Ching Chan William W Sharr Tan To Cheung Albert CY Chan simon hy tsang Kenneth SH Chok Kin Chung Leung Chung Mau Lo Department of Surgery The University of Hong Kong State Key Laboratory for Liver Research The University of Hong Kong Department of Pathology The University of Hong Kong

The removal of tumor together with the native liver in living donor liver transplantation for hepatocellular carcinoma is challenged by a very close resection margin if the tumor abuts the inferior vena *** is in contrast to typical deceased donor liver transplantation where the entire retrohepatic inferior vena cava is included in total *** we report a case of deroofing the retrohepatic vena cava in living donor liver transplantation for caudate hepatocellular *** order to ensure clear resection margins,the anterior portion of the inferior vena cava was *** right liver graft was inset into a Dacron vascular graft on the back table and the composite graft was then implanted to the recipient inferior vena *** this technique,we observed the no-touch technique in tumor removal,hence minimizing the chance of positive resection margin as well as the chance of shedding of tumor cells during manipulation in operation.

关键词： hepatocellular carcinoma liver transplantation

Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability

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World Journal of Gastroenterology 2014年第46期20卷 17448-17455页

作者： Tan To Cheung Ronnie TP Poon Kenneth SH Chok Albert CY Chan simon hy tsang Wing Chiu Dai See Ching Chan Sheung Tat Fan Chung Mau Lo Department of Surgery Queen Mary HospitalUniversity of Hong Kong

AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.

关键词： Adjuvant therapy Head of pancreas Liver transplant Morbidity Mortality Portal vein resection Survival analysis Whipple operation

Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

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World Journal of Hepatology 2016年第15期8卷 644-648页

作者： Wong Hoi She Tan To Cheung Wing Chiu Dai simon hy tsang Albert CY Chan Daniel KH Tong Gilberto KK Leung Chung Mau Lo Department of Surgery Queen Mary Hospital the University of Hong Kong

AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the ***: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the ***: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable(65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival(91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality(P = 0.004, hazard ratio = 1.035, 95%CI:CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

关键词： Non-operative management Liver trauma Multiple injuries Penetrative trauma Liver laceration Blunt trauma

High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients

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World Journal of Gastroenterology 2013年第20期19卷 3083-3089页

作者： Tan To Cheung Sheung Tat Fan See Ching Chan Kenneth SH Chok Ferdinand SK Chu Caroline R Jenkins Regina CL Lo James YY Fung Albert CY Chan William W Sharr simon hy tsang Wing Chiu Dai Ronnie TP Poon Chung Mau Lo Department of Surgery the University of Hong Kong State Key Laboratory for Liver Research the University of Hong Kong Department of Diagnostic Radiology the University of Hong Kong Department of Anaesthesiology The University of Hong Kong Department of Pathology the University of Hong Kong Department of Medicine the University of Hong Kong

AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 ***-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before *** patients received HIFU ablation as a bridging *** five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for *** were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of ***:The HIFU group and TACE group showed no difference in terms of tumor size and tumor *** patient in the HIFU group and no patient in the TACE group had gross *** median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication *** the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the *** the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced *** may reduce the drop-out rate of liver transplant candidate.

关键词： Ablation Bridging therapy Cirrhosis Hepatocellular carcinoma High-intensity focused ultrasound Liver transplant New technology

A joint computational-experimental study of intracranial aneurysms:Importance of the aspect ratio

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Journal of hydrodynamics 2016年第3期28卷 462-472页

作者： simon Sui-Man LAI Abraham Yik-Sau TANG Anderson Chun-On tsang Gilberto Ka-Kit LEUNG Alfred Cheuk-Hang YU Kwok Wing CHOW Department of Electrical and Electronic Engineering University of Hong Kong Hong Kong China Department of Mechanical Engineering University of Hong Kong Hong Kong China Department of Surgery Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong China Department of Electrical and Computer Engineering University of Waterloo Ontario Canada

Rupture of a cerebral aneurysm （abnormal swelling of blood vessel in the brain） will cause subarachnoid hemorrhage, and will result in an alarming rate of mortality and morbidity. A joint computational-experimental study is conducted to assess the importance of the aspect ratio in the dynamics of blood flow. The aspect ratio is defined here to be the ratio of the height of the aneurysm to the linear dimension of the neck. Idealized models of such aneurysms located near a bifurcation point were investigated. Numerical simulations for hemodynamic properties like shear stress and flow rate were performed. The computational results were verified experimentally with specially fabricated phantoms, blood mimicking fluid and Doppler ultrasound imaging. Excellent agreements were obtained. Two features are highlighted, providing information in the intensely debated link between rupture risk and geometric factors. On increasing the aspect ratios, firstly, a jet impinging on the distal part of the neck can be observed, and secondly, a region of positive shear stress gradient can be found there. Furthermore, computational analyses for four patient-specific models were conducted to correlate with the results of idealized models and to provide further clinical insight.

关键词： intracranial aneurysms aspect ratio Doppler ultrasound