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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 373-375页

作者： ka wing ma Albert Chi Yan Chan Department of Surgery Li Ka Shing Faculty of Medicinethe University of Hong KongHong KongChina

Insufficient future liver remnant(FLR)represented one of the most common contraindications for major hepatectomy as post-hepatectomy liver failure(PHLF)was associated with high mortality with no effective *** the description of portal vein embolization(PVE)by makucchi in 1984(1),FLR volumetric modulation was made *** of PVE before major hepatectomy for patients with insufficient FLR(i.e.,mated standard liver volume)had greatly improved resectability.

关键词： hepatectomy mortality liver

A review on radiofrequency,microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis

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Hepatobiliary Surgery and Nutrition 2021年第2期10卷 193-209页

作者： Tan To Cheung ka wing ma Wong Hoi She Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina

Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease *** transplantation theoretically provides an ultimate solution to the disease,but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some *** an ideal situation,a treatment that is safe and effective should provide a better outcome for patients with the ***:This article aims to give a comprehensive review of various types of loco-ablative treatment for *** Review:Loco-ablative treatment bridges the gap between surgical resection and transarterial *** types of ablative therapy have their unique ability,and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their ***:Radiofrequency ablation(RFA)has a relatively longer history and more evidence to support its *** ablation(MWA)is gaining momentum because of its shorter ablation time and consistent ablation ***-intensity focused ultrasound(HIFU)ablation is a relatively new technology that provides non-invasive treatment for patients with *** has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver *** and Relevance:Selective use of different loco-ablative therapies will enhance clinicians’treatment options for treatment of HCC.

关键词： High-intensity focused ultrasound(HIFU) hepatocellular carcinoma(HCC) liver cancer radiofrequency ablation(RFA) microwave ablation(MWA) survival non-invasive treatment ablation cirrhosis complication

Importance of surgical margin in the outcomes of hepatocholangiocarcinoma

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World Journal of Hepatology 2017年第13期9卷 635-641页

作者： ka wing ma 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

AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from1995 to 2014 were *** with pathologically confirmed HCC-CC were included for ***,biochemical,operative and pathological data were analyzed against survival outcomes. RESULTSForty-two patients were included for *** median age was 53.5 *** were 29 *** B virus was identified in 73.8%of the *** patients had preserved liver *** median preoperative indocyanine green retention rate at 15 min was 10.2%.The median tumor size was 6.5 *** hepatectomy was required in over 70%of the *** was performed in 6 *** hospital death *** median hospital stay was 13 *** median follow-up period was 32 *** 5-year disease-free survival and overall survival were 23.6%and 35.4%*** was the only independent factor associated with diseasefree survival[Pmargin of≥1 cm was associated with improved 1-year disease-free survival(40%vs 0%;log-rank,P=0.012).CONCLUSIONHCC-CC is a rare disease with poor *** margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.

关键词： Hepatocholangiocarcinoma Hepatocellular cholangiocarcinoma Survival Hepatectomy Resection margin

Liver Transplantation for Hepatitis B Virus-related Hepatocellular Carcinoma in Hong Kong

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 283-288页

作者： ka wing ma Kenneth Siu Ho Chok James Yan Yue Fung Chung mau Lo Department of Surgery The University of Hong KongHong KongChina State Key Laboratory for Liver Research The University of Hong KongHong KongChina Department of Medicine The University of Hong KongHong KongChina

Hepatocellular carcinoma(HCC)is the fifth most common cancer and the third most common cause of cancer-related deaths *** resection is frequently limited in Hong Kong by hepatitis B virus-related cirrhosis,and liver transplantation is the treatment of *** transplanta-tion has been shown to produce superior oncological benefits,when compared to hepatectomy for *** developments in the context of patient selection criteria,modification of organ allocation,bridging therapy,salvage liver transplanta-tion and pharmaceutical breakthrough have improved the survival of HCC *** this article,we will share our experience in transplanting hepatitis B virus-related HCC patients in Hong Kong and discuss the recent progress in several areas of liver transplantation.

关键词： Liver transplantation Hepatitis B Hepatocel ular carcinoma Review

Experience of living donor liver transplantation for hepatocellular carcinoma in the University of Hong Kong Hospital

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Hepatoma Research 2022年第1期8卷 90-105页

作者： Janice Hoi man Mok ka wing ma Kenneth Siu Ho Chok Li ka Shing Faculty of Medicine The University of Hong KongHong KongChina Department of Surgery The University of Hong KongHong KongChina

Aim:To describe the current practise of living donor liver transplantation(LDLT)for hepatocellular carcinoma(HCC),including the patient selection criteria,surgical techniques,management of small-for-size syndrome,postoperative complications,and the results of our units,in the Liver Transplant Centre of Queen mary Hospital,Hong Kong,one of the high-volume centres for LDLT in ***:Our centre practises careful selection for HCC patients using the University of California,San Francisco(UCSF)criteria,supplemented by alpha-fetoprotein level and the model for end-stage liver disease *** flexibility is offered to enthusiastic donors and recipients in LDLT while balancing the risks and *** pioneered in using the extended right lobe graft and the novel hepatic venoplasty technique,which lessen the risk of hyperperfusion and small-for-size syndrome with improved overall recipient *** were collected prospectively and presented as the mean values and ranges,or the number of patients in proportion of total patient ***:Of our patients,74.9% met the UCSF criteria,and 64.5% met the Milan criteria.A 5-year overall and disease-free survival rate of 78.9% and 76.3% were ***:LDLT is an ideal treatment for HCC in Hong Kong with regard to the critical organ shortage and high demand for *** current surgical techniques and post-transplant surveillance contribute to the positive outcome.

关键词： Living donor liver transplantation hepatocellular carcinoma high volume centre LDLT HCC

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

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

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

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,Pmaller tumour size(4 vs.10 cm,Pmatching for serum AFP levels and tumour size,1-,3-and 5-year overall survival for LT were 81 ng/mL,3.9 cm,80%,70%and 70%and the corresponding rates for LR were 1,417 ng/mL,5.3 cm,51.8%,19,6%and 9.8%(P value=0.12,0.27 and 0.009 respectively).Conclusions:LT is associated with significantly better oncological 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.

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