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World Journal of Gastroenterology 2005年第29期11卷 4465-4471页

作者： Mike SL Liem Ronnie TP Poon chung mau lo Wai Kuen Tso Sheung Tat Fan the Dutch Cancer Society Queen Wilhelmina Fund Amsterdam The Netherlands Centre for the Study of Liver Disease and Departments of Surgery and Radiology The University of Hong Kong Pokfulam Hong Kong China Department of Radiology The University of Hong Kong Pokfulam Hong Kong China

AIM： To evaluate the outcome of transarterial chemoembolization （TACE）in patients with unresectable hepatocellular cardnoma （HCC）〈5 cm in diameter eligible for radiofrequency ablation （RFA）. METHODS： The treatment-related mortality, morbidity, long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated. RESULTS： Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level （AFP） and the size of the largest tumor 〉3 cm in diameter were adverse prognostic factors in multivariate analysis. CONCLUSION： The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.

关键词： Hepatocellular carcinoma Radiofrequency ablation Transarterial chemoembolization

Liver transplantation:would it be the best and last chance of cure for hepatocellular carcinoma with major venous invasion?

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 308-314页

作者： Ka Wing Ma Albert Chi Yan Chan Kenneth Siu Ho Chok Wong Hoi She Tan To Cheung Wing Chiu Dai James Yan Yue Fung chung mau lo Department of Surgery The University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina

Background:Hepatocellular carcinoma(HCC)with portal vein tumour thrombus(PVTT)signifies advanced disease,whether LT confers any survival superiority over resection remains ***:A propensity score matched(PSM)analysis of liver transplantation(LT)and liver resection(LR)for HCC with PVTT was ***:A consecutive series of 88 patients who received either LT(10 DDLTs and 3 LDLTs)or LR(n=75)respectively were *** PSM,the LT group has a higher MELD score(17.3 vs.7.8,Plower serum AFP levels(96 vs.2,164 ng/mL,P=0.017)and smaller tumour size(4 vs.10 cm,Plogical outcomes in HCC patients with PVTT involving the lobar or segmental level.A modest expansion of selection criteria to include small HCC with segmental PVTT should be considered.

关键词： Liver transplantation(LT) portal vein tumour thrombus liver resection(LR)Submitted Aug 10,2019.Accepted for publication Oct 15,2019.

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

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

Role of C11-FDG dual-tracer PET-CT scan in metastatic screening of hepatocellular carcinoma-a cost-effectiveness analysis

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 301-307页

作者： Kevin K.W.Chu Albert C.Y.Chan Ka Wing Ma Wong Hoi She Wing Chiu Dai Kenneth S.H.Chok Tan To Cheung chung mau lo Department of Surgery The University of Hong KongHong KongChina

Background:We aimed to identify predictive factors for positron emission tomography(PET)-detected hepatocellular carcinoma(HCC)metastasis and a cost-effective approach to preoperative PET-computed tomography(CT)for detecting ***:Clinicopathological and survival data of HCC patients having PET-CT with 18F-fludeoxyglucose(FDG)and 11C-acetate(ACT)following contrast-enhanced CT/magnetic resonance imaging(MRI)for preoperative tumor staging were *** logistic regression was performed to identify predictive factors for PET-detected metastasis.A cost-benefit analysis model was built for the incurred costs and the impact of PET-CT findings on treatment strategy was ***:Totally 152 patients were ***-tracer PET-CT detected metastasis in 17 patients(11%).By multivariate analysis,alpha-fetoprotein(AFP)≥400 ng/mL[relative risk(RR):4.30,95%confidence interval(CI):1.41-13.15,P=0.011]and bilobar disease(RR:3.94,95%CI:1.24-12.52,P=0.014)were independent predictive factors for PET-detected ***-CT findings altered the treatment strategy for 12 patients(7.9%);three partial hepatectomies,eight episodes of transarterial chemoembolization(TACE)and one episode of ablation were avoided,with an estimated cost-saving of US$91,000,$150,000 and$10,600 *** the PET-CT been performed only for patients with AFP≥400 ng/mL or bilobar disease(n=74),metastasis would have been confirmed in 14 patients(18.9%),and the cost-saving per patient was estimated at US$1,***:Dual-tracer PET-CT is cost-effective and useful for preoperative HCC staging in patients with AFP≥400 ng/mL or bilobar *** routine use in preoperative workup for all HCC patients is not *** disease with AFP<400 ng/mL can achieve good negative predictive value for PET-detected *** patients with either factor can avoid unnecessary procedures and is thus cost-effective for preoperative HCC workup.

关键词： Cost-effectiveness study dual-tracer positron emission tomography-computed tomography(dual-tracer PET-CT) hepatocellular carcinoma(HCC) metastatic screening preoperative investigation

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 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

Estimating liver weight of adults by body weight and gender

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World Journal of Gastroenterology 2006年第14期12卷 2217-2222页

作者： See Ching Chan Chi Leung Liu chung mau lo Banny K Lam Evelyn W Lee Yik Wong Sheung Tat Fan Centre for the Study of Liver Disease Department of Surgery The University of Hong Kong Pokfulam Hong Kong China Centre for the Study of Liver Disease Department of Radiology The University of Hong Kong Pokfulam Hong Kong China

AIM： To estimate the standard liver weight for assessing adequacies of graft size in live donor liver transplantation and remnant liver in major hepatectomy for cancer. METHODS： In this study, anthropometric data of body weight and body height were tested for a correlation with liver weight in 159 live liver donors who underwent donor right hepatectomy including the middle hepatic vein. Liver weights were calculated from the right lobe graft weight obtained at the back table, divided by the proportion of the right lobe on the computed tomography. RESULTS： The subjects, all Chinese, had a mean age of 35.8 ± 10.5 years, and a female to male ratio of 118：41. The mean volume of the right lobe was 710.14 ±131.46 mL and occupied 64.55%±4.47% of the whole liver on computed tomography. Right lobe weighed 598.90±117.39 g and the estimated liver weight was 927.54 ± 168.78 g. When body weight and body height were subjected to multiple stepwise linear regression analysis, body height was found to be insignificant. Females of the same body weight had a slightly lower liver weight. A formula based on body weight and gender was derived： Estimated standard liver weight （g）=218＋BW （kg）× 12.3＋gender×51 （R^2 = 0.48）（female=0, male= 1）. Based on the anthropometric data of these 159 subjects, liver weights were calculated using previously published formulae derived from studies on Caucasian, .lapanese, Korean, and Chinese. All formulae overestimated liver weights compared to this formula. The Japanese formula overestimated the estimated standard liver weight （ESLW） for adults less than 60 ***： A formula applicable to Chinese males and females is available. A formula for individual races appears necessary.

关键词： Estimated standard liver weight Liver tranplantation

Experience of donor right lobe hepatectomy in adult-to-adult live donor liver transplantation: clinical analysis of 89 cases

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Hepatobiliary & Pancreatic Diseases International 2002年第2期1卷 166-171页

作者： Sheung-Tat Fan chung-mau lo Chi-Leung Liu From the Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China Centre for the Study of Liver Disease and Department of Surgery University of Hong Kong Medical Centre Queen Mary Hospital Hong Kong China. hrmsfst@hkucc.hku.hk

Objective: To review the experience of donor selec- tion and right lobe hepatectomy in adult-to-adult live donor liver transplantation. Methods: From May 1996 to December 2001, 89 live donor liver transplants using right lobe grafts were performed at Queen Mary Hospital, Hong Kong. All donors had received psychological counseling before donor operations. They were screened by laboratory tests including complete blood cell count, liver and renal biochemistry, and viral serology studies. Com- puted tomography (CT), CT volumetry and hepatic arteriography were routinely performed. All donors underwent the operations using the method designed by us. Results: The median duration of the operations was 8.8 hours. The median blood loss recorded 466 ml. The median intensive care unit and hospital stays were 2 and 10 days, respectively. There was no do- nor mortality. Complications of donor operations in- cluded wound infection, urinary tract infection, bili- ary stricture, cholestasis, subphrenic collection, bowel obstruction and incision hernia, etc. All do- nors have recovered and returned to their previous occupations. Conclusions: Live donation of right lobe grafts for a- dult-to-adult liver transplantation is safe, provided that donor selection is strict and utmost care is exer- cised during the operation.

关键词： right lobe graft liver transplantation hepstectomy

Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes

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World Journal of Gastroenterology 2010年第24期16卷 3056-3062页

作者： Tan To Cheung Kelvin K Ng Kenneth S Chok See Ching Chan Ronnie T Poon chung mau lo Sheung Tat Fan Department of Surgery The University of Hong Kong 102 Pok Fu Lam Road Queen Mary Hospital

AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical ***: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were ***: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had few

关键词： Hepatocellular carcinoma Radiofrequency ablation Combined resection Resection Cirrhosis

A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma

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World Journal of Gastroenterology 2010年第4期16卷 526-530页

作者： Tan To Cheung Kelvin Kwok-chai Ng Ronnie Tung-ping Poon See Ching Chan chung mau lo Sheung Tat Fan Department of Surgery The University of Hong Kong 102 PokFu Lam RoadQueen Mary HospitalHong Kong China

Conventional hepatectomy is an effective way to treat hepatocellular ***,it is invasive and *** use of laparoscopy in hepatectomy,while technically demanding,reduces surgical invasiveness and stressfulness but still achieves complete resection with adequate *** with conventional hepatectomy,laparoscopic hepatectomy provides a better chance and situation for further surgery in the case of recurrence of hepatocellular *** aged patients can successfully endure repeated hepatectomy using laparoscopy,as shown in the present *** report presents a case of repeated laparoscopic hepatectomy treating hepatocellular carcinoma and its recurrence in an aged patient having cirrhosis,a disease causing extra difficulty for performing laparoscopic *** report also describes techniques of the operation and displays characteristic results of laparoscopic hepatectomy such as smaller wounds,less blood loss,less pain,less scars and adhesion,shorter postoperative hospital stay,and faster recovery.

关键词： Hepatocellular carcinoma Laparoscopic resection Recurrent hepatocellular carcinoma Elderly Hepatectomy