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Hepatopancreatoduodenectomy for advanced hepatobiliary malignancies: a single-center experience

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Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 382-386页

作者： wing chiu dai Kenneth SH Chok Tan To Cheung Albert CY Chan See Ching Chan Chung Mau Lo Department of Surgery Queen Mary HospitalThe University of Hong Kong102 Pok Fu Lam RoadHong KongChina

BACKGROUND: Hepatopancreatoduodenectomy is a complicated and challenging procedure but necessary for curative resection for advanced hepatobiliary malignancies. This retrospective study was to examine the safety and survival outcomes of hepatopancreatoduodenectomy in our center. METHODS: Prospectively collected data of 12 patients who underwent hepatopancreatoduodenectomy for advanced hepatobiliary malignancies in our hospital from January 1998 to December 2014 were analyzed. The primary endpoints are treatment-related morbidity and mortality and the secondary endpoints are overall survival and disease-free survival. RESULTS: Curative resection was achieved in 11 (91.7%) patients. Complications developed in 10 (83.3%) patients. Three hospital deaths resulted from multiorgan failure secondary to postoperative pancreatic fistula or hepaticojejunostomy leakage. Six of the nine remaining patients had disease recurrence. The nine patients had a median survival of 39.8 (5.3-151.8) months. The 1-, 3- and 5-year overall survival rates were 66.7%, 55.6% and 27.8%, respectively. The corresponding disease-free survival rates were 55.6%, 44.4% and 29.6%, respectively. CONCLUSIONS: Morbidity and mortality after hepatopancreatoduodenectomy were significant. With RO resection, the 5-year overall survival and disease-free survival rates were 27.8% and 29.6%, respectively.

关键词： hepatectomy hepatopancreatoduodenectomy malignancy pancreaticojejunostomy pancreatoduodenectomy

Donor ductal anomaly is not a contraindication to right liver lobe donation

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 343-347页

作者： Kenneth SH Chok James YY Fung wing chiu dai Sui Ling Sin Ka wing Ma Albert CY Chan Tan To Cheung Chung Mau Lo Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina State Key Laboratory for Liver Research The University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Medicine The University of Hong Kong102 Pok Fu Lam RoadHong KongChina

Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in *** retrospective study aimed to determine if the occurrence of postoperative biliary stricture in donors or recipients in rightlobe LDLT(RLDLT)is related to donor biliary anatomy ***:We analyzed our RLDLT recipients’clinical data and those of their graft *** recipients were divided into 2 groups:with and without postoperative biliary *** 2 groups were *** primary endpoints were donor biliary anatomy type and postoperative biliary complication incidence;the secondary endpoints were 1-,3-and 5-year graft and patient survival ***:Totally 127 patients were included in the study;25(19.7%)of them developed biliary anastomotic *** these 25 patients,16 had type A biliary anatomy,3 had type B,2 had type C,3 had type D,and 1 had type *** the 127 donors,96(75.6%)had type A biliary anatomy,13(10.2%)had type B,6(4.7%)had type C,10(7.9%)had type D,and 2(1.6%)had type *** stricture was seen in 2 donors,who had type A biliary *** of the recipients or donors developed bile *** association between the occurrence of postoperative biliary stricture and donor biliary anatomy type was found(P=0.527).Conclusions:The incidence of biliary stricture in donors or recipients after RLDLT was not related to donor biliary anatomy *** postoperative complications were similar in whatever type of donor bile duct anatomy,donor ductal anomaly should not be considered a contraindication to donation of right liver lobe.

关键词： Living donor liver transplantation Right liver donation Biliary complications Cholangiograms Ductal anomaly

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

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

Emergency ABO-incompatible living donor liver transplant for patients with ultrahigh MELD scores

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 87-89页

作者： Kevin KW Chu Kenneth SH Chok James YY Fung Albert CY Chan wing chiu dai Chung Mau Lo Department of Surgery Queen Mary Hospital The University of Hong Kong Department of Medicine Queen Mary Hospital The University of Hong Kong

To the Editor:A 49-year-old Chinese man with treatment-naive chronic hepatitis B presented with a one-week history of jaundice when admitted to our *** admission,his bilirubin was 704μmol/L,alanine aminotransferase 180 U/L,international normalized ratio 2.4,creatinine 140μmol/L,and Model for End-stage Liver Disease(MELD)score *** serum HBV DNA was 64.7 IU/mL,and he was commenced on ***,he developed acute-onchronic liver failure on day 28 with grade 2 hepatic encephalopathy and a MELD score of 40(bilirubin 709μmol/L,international normalized ratio 3.3,creatinine 181μmol/L).

关键词： Editor hospital

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

Monday blues of deceased-donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2011年第1期10卷 26-29页

作者： See Ching Chan wing chiu dai Chung Mau Lo Banny Lam Yuen Man Kwan Wai Yi Ho Sheung Tat Fan Department of Surgery Queen Mary HospitalThe University of Hong Kong

BACKGROUND:There is a constant and global shortage of deceased-donor organs for *** to identify areas for securing potential deceased-donor organs may improve the supply and hence benefit more patients in need of transplantation. METHODS:We looked into the disparity of the number of deceased-donor liver transplantation(DDLT)performed at our hospital on different days of the weeks from January 2000 to the end of December 2009(237 DDLTs).The number of DDLT performed on each day was compared with the other days of the week. RESULTS:It was apparent that there were fewer DDLTs on Mondays,as shown by the numbers of DDLT performed on different days of the week in an ascending order:Monday 18(7.6%),Sunday 30(12.7%),Thursday 34(14.3%),Friday 36(15.2%),Wednesday 38(16.0%),Tuesday 40(16.9%), and Saturday 41(17.3%).The difference reached statistical significance when Monday was compared with Tuesday (P=0.019),Wednesday(P=0.010),Friday(P=0.021),and Saturday(P=0.007).It was twice as unlikely a DDLT would be performed on Monday as compared with other *** a trend did not change even with an increase in the number of deceased-donor liver grafts in the last *** consent to donation was obtained from the donor family the day before DDLT,fewer consents were thus obtained on ***:These findings suggested that deceased-donor organ donation activities were less active on Sundays and could be *** further raises the concern of possible wastage of potential cases of organ donation.

关键词： deceased-donor liver transplantation graft shortage organ donation

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

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