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Associating liver partition and portal vein ligation for staged hepatectomy： the current role and development

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hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 17-26页

作者： Wan Yee lau Eric ch Lai Stephanie hY lau Faculty of Medicine The Chinese University of Hong Kong Shatin New Territories Department of Surgery Pamela Youde Nethersole Eastern Hospital Department of Surgery Queen Elizabeth Hospital Hong Kong China

BACKGROUND： Associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） has recently been developed to induce rapid liver hypertrophy and reduce posthepatectomy liver failure in patients with insufficient future liver remnant （FLR）. ALPPS is still considered to be in an early developmental phase because surgical indications and techniques have not been standardized. This article aimed to review the current role and future developments of ALPPS. DATA SOURCES： Studies were identified by searching MED- LINE and PubMed for articles from January 2007 to October 2016 using the keywords ＂associating liver partition and portal vein ligation for staged hepatectomy＂ and ＂ALPPS＂ Addi- tional papers were identified by a manual search of references from key articles. RESULTS： ALPPS induces more hypertrophy of the FLR in less time than portal vein embolization or portal vein ligation. The benefits of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% com- pletion rate of the second stage of ALPPS. The main criticisms of ALPPS are centered on its high morbidity and mortality rates. Morbidity rates after ALPPS have been reported to be 15.3%-100%, with ≥ the Clavien-Dindo grade III morbidity of 13.6%-44%. Mortality rates have been reported to be 0%-29%. The important questions to ask even if oncologic long-term results are acceptable are： whether the gain in quality and quantity of life can be off balance by the substantial risks of morbidity and mortality, and whether stimulation of rapid liver hypertrophy also accelerates rapid tumor progression and spread. Up till now, the documentations of the ALPPS procedure come mainly from case series, and most of these series include heterogeneous groups of malignancies. The numbers are also too small to separately evaluate survival for different tumor etiologies. CONCLUSIONS： Currently, knowledge on ALPPS is limited, and prospective randomized studies are lacking. From th

关键词： associating liver partition and portal vein ligation for staged hepatectomy portal vein embolization laparoscopy colorectal liver metastases hepatocellular carcinoma

Modifications of ALPPS–from complex to more complex or from complex to less complex operations

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hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 346-352页

作者： Wan Yee lau Eric ch Lai Faculty of Medicine The Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina Department of Surgery Pamela Youde Nethersole Eastern HospitalHong Kong SARChina

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed to induce rapid liver hypertrophy to reduce the chance of post-hepatectomy liver failure in patients with borderline or insufficient future liver remnant. ALPPS is still in an early developmental stage and its techniques have not been standardized. This study aimed to review the technical modifications of the conventional ALPPS procedure. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles published from January 2007 to December 2016 using the keywords 'associating liver partition and portal vein ligation for staged hepatectomy' and 'ALPPS'. Additional articles were identified by a manual search of references from key articles. RESULTS: There have been a lot of modifications of the conventional ALPPS. These are classified as: (1) modifications aiming to improve surgical results; (2) modifications aiming to expand surgical indications; (3) salvage ALPPS; (4) ALPPS using the minimally invasive approach. Some of these modifications have made the conventional ALPPS procedure to become even more complex, although there have also been other attempts to make the procedure less complex. The results of most of these modifications have been reported in small case series or case reports. We need better well-designed studies to establish the true roles of these modifications. however, it is interesting to see how this conventional ALPPS procedure has evolved since its introduction. CONCLUSIONS: There is a trend for the use of minimally invasive procedure in the phase 1 or 2 of the conventional ALPPS procedure. Some of these modifications have expanded the use of ALPPS in patients who have been considered to have unresectable liver tumors. The long-term oncological outcomes of these modifications are still unknown.

关键词： associating liver partition and portal vein ligation for stage hepatectomy hepatocellular carcinoma hepatectomy liver metastasis portal vein embolization

hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model

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hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 516-520页

作者： Wan-Yee lau Eric ch Lai Department of hepatic and Biliary Surgery First Affiliated hospital Guangxi Medical University Faculty of Medicine the Chinese University of Hong Kong Shatin New Territories Hongkong SAR China

BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METhODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to h 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and h 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to h 2 O. There was a significant drop in DO 2 when the CVP was h 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was h 2 ***: The optimal CVP for hepatic resection is 2to 3 cmh2O.

关键词： hepatectomy hemorrhage central venous pressure tissue oxygenation hemodynamics

Parentage testing anomalies in hong Kong SAR of china

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chinese Medical Journal 2003年第5期116卷 708-711页

作者： Richard A Collins Wing See Wu Lok-Ting lau Albert ch Yu hong Kong DNA chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon Hong Kong SAR ChinaHong Kong DNA Chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon Hong Kong SAR ChinaHong Kong DNA Chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon Hong Kong SAR ChinaHong Kong DNA Chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon Hong Kong SAR China

Objective To determine if there are any differences in the number of exclusions from paternity of men using an anonymous parentage testing service compared with that of men using an in-person parentage testing service provided by the same company in hong Kong SAR of china. Methods Comparable numbers of consecutive anonymous and in-person parentage tests conducted by the same company were analyzed. Results Men using an anonymous parentage testing service were excluded from paternity at a significantly greater rate (Ph men using an in-person parentage test service. Conclusions The results obtained from anonymous parentage testing indicate that the number of families containing children of doubtful parentage is much greater than expected previously. As illegitimate children are known to suffer greater degrees of abuse and neglect, this finding poses serious social questions regarding the welfare of families, which the relevant authorities should acknowledge and address.

关键词： parentage testing short tandem repeat combined probability index polymerase chain reaction

Identification of optimal contemporary antiemetic prophylaxis for doxorubicin-cyclophosphamide chemotherapy in chinese cancer patients: post-hoc analysis of 3 prospective studies

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Cancer Biology & Medicine 2021年第3期18卷 825-832页

作者： Winnie Yeo Leung Li Thomas Kh lau Kwai T Lai Vicky,TC chan Kwan h Wong christopher ch Yip Elizabeth Pang Maggie cheung Vivian chan Carol ch Kwok Joyce JS Suen Frankie KF Mo Department of Clinical Oncology Prince of Wales HospitalFaculty of MedicineHong Kong Cancer InstituteHong KongChina State Key Laboratory of Translational Oncology The Chinese University of Hong KongHong KongChina Department of Clinical Oncology Princess Margaret HospitalHong KongChina

Objective:chemotherapy-induced nausea and vomiting(CINV)are common with doxorubicin-cyclophosphamide(AC)*** antiemetic regimens incorporate neurokinin-1 receptor antagonist(NK1 RA),5-hydroxytryptamine type-3 receptor antagonist(5 hT3 RA),corticosteroid,and dopamine *** post-hoc analysis compared results of 3 prospective antiemetic studies conducted among chinese breast cancer patients who received(neo)adjuvant AC,in order to identify optimal antiemetic ***:A total of 304 patients were included:Group 1,ondansetron/dexamethasone(D1);Group 2,aprepitant/ondansetron/dexamethasone(D1);Group 3,aprepitant/ondansetron/dexamethasone(D1–3);Group 4,aprepitant/ondansetron/dexamethasone(D1–3)/olanzapine;and Group 5,netupitant/palonosetron/dexamethasone(D1–3).Antiemetic efficacies of Groups 3,4,and 5 during cycle 1 of AC were individually compared with Group *** addition,emesis outcomes of patients in Groups 3 and 5,and those of Groups 2 and 3,were ***:When comparing efficacies of a historical doublet(5 hT3 RA/dexamethasone)with triplet antiemetic regimens(NK1 RA/5 hT3 RA/dexamethasone)with/without olanzapine,complete response(CR)percentages and quality of life(QOL)in overall phase of cycle 1 AC were compared between Group 1 and the other groups:Group 1 vs.3,41.9%vs.38.3%(P=0.6849);Group 1 vs.4,41.9%vs.65.0%(P=0.0107);and Group 1 vs.5,41.9%vs.60.0%(P=0.0460).Groups 4 and 5 achieved a better *** comparing netupitant-based(Group 3)with aprepitant-based(Group 5)triplet antiemetics,CR percentages were 38.3%vs.60.0%,respectively(P=0.0176);Group 5 achieved a better *** comparing 1 day(Group 2)vs.3 day(Group 3)dexamethasone,CR percentages were 46.8%and 38.3%,respectively(P=0.3459);Group 3 had a worse ***:Aprepitant-containing triplets were non-superior to doublet ***-containing triplets and adding olanzapine to aprepitant-containing triplets were superior to ***/palono

关键词： Netupitant palonosetron aprepitant olanzapine NEPA Asians

Parentage testing anomalies in hong Kong SAR of china

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中华医学杂志(英文版) 2003年第5期 66-69页

作者： Richard A Collins,Wing See Wu,Lok-Ting lau ,Albert ch Yu hong Kong DNA chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon hong Kong SAR china hong Kong DNA chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon hong Kong SAR china hong Kong DNA chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon hong Kong SAR china hong Kong DNA chips Limited 1805-6 18/F Lu Plaza 2 Wing Yip Street Kowloon hong Kong SAR china

关键词： parentage testing · short tandem repeat · combined probability index · polymerase chain reaction

Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

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hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 520-524页

作者： cheng-Xin Lin Ya Guo Wan Yee lau Guang-Ying Zhang Yi-Ting huang Wen-Zheng he Eric ch Lai Department of Anesthesiology First Affiliated hospital of Guangxi Medical University Department of hepatic and Biliary Surgery First Affiliated hospital of Guangxi Medical University Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue *** prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(hCC).METhODS:Ninety-seven patients who underwent partial hepatectomy for hCC had their CVP controlled at a level of 0 to 5 mmhg during hepatic parenchymal *** systolic blood pressure(SBP) was maintained,if possible,at 90 mmhg or *** B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 *** average clamp time was 21.4±8.0 *** patients were divided into 5 groups based on the CVP:group A:0-1 mmhg;B:1.1-2 mmhg;C:2.1-3 mmhg;D:3.1-4 mmhg and E:4.1-5 *** blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were ***:With active fluid load,a constant SBP ≥90 mmhg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in *** to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,Ph the baseline,the blood oxygenation decreased significantly when the CVP was *** excess and hCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(PhCO 3-,a CVP of 2.1-3 mmhg was optimal in patients undergoing partial hepatectomy for hCC.

关键词： central venous pressure hepatectomy blood loss

Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach

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hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 508-512页

作者： Ying-Jun chen Zuo-Jun Zhen huan-Wei chen Eric ch Lai Fei-Wen Deng Qing-han Li Wan Yee lau Department of Liver Surgery The First People's Hospital of Foshan Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle＇s maneuver, especially in patients with ***： From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie ***： The types of liver resection included right hepatectomy（n1）, right posterior sectionectomy（n1）, left hepatectomy and common bile duct exploration（n1）, segment 4b resection（n1）, left lateral sectionectomy（n2）, and wedge resection（n2）. Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3minutes. The mean duration of vascular inflow occlusion was54.5 minutes. The mean intraoperative blood loss was 361 *** patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 ***： Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approachwas safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.

关键词： laparoscopic liver resection hepatectomy vascular control liver neoplasm hilar plate

Impregnation of carbonaceous nanofibers into glassy polymer-based composite membrane for CO_2 separation

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chinese Journal of chemical Engineering 2018年第11期26卷 2385-2390页

作者： Pannir Selvam Murugiah Pei ching Oh Kok Keong lau CO_2 Research Centre Institute of Contaminant ManagementChemical Engineering DepartmentUniversiti Teknologi PETRONAS

The development of defect-free composite membrane(CM) is often challenging due to poor dispersion and distribution of filler particles in the polymer matrix. Despite the attractive physicochemical properties and gas separation performance of carbon nanotube(CNT) based CM, CNT displayed poor dispersion characteristics in most polymer matrix domain. Instead of incorporating CNT, a viable alternative, carbon nanofiber(CNF) which exhibits similar properties as CNT, but improved dispersion quality in the polymer matrix is found. In this work,CNF particles were incorporated in poly(2,6-dimethyl-1,4-phenylene oxide)(PPOdm) polymer continuous phase for CM development. The optimum gas separation performance of the PPOdm-CNF CM(11.25 at 197.02 barrer of CO_2 permeability) was obtained at 3 wt% of CNF loading. Compared to pristine PPOdmmembrane,CO_2 permeability and CO_2/ch_4 selectivity of PPOdm-3 wt% CNF CM were enhanced by 180% and 55%, *** 3 wt% CNF loading, the filler particles were dispersed and distributed more homogenously, in which no obvious CNF agglomeration was observed. In addition, the incorporation of CNF particles also enhanced the mechanical and thermal properties of the resultant CM.

关键词： Carbon nanofiber Composite membrane Carbon dioxide Gas separation