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Life made easy:simplifying reconstruction for dual portal veins in adult right lobe live donor liver transplantation

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hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 547-549页

作者： Albert C.Y.Chan Chung Mau Lo kenneth s.h.chok see Ching Chan sheung Tat Fan Department of surgery The University of Hong KongQueen Mary Hospital

In live donor liver transplantation, anatomical anomalies of the portal vein are more frequently encountered in right lobe than left lobe grafts. Of these, a dual portal vein is one of the most common anatomical anomalies encountered. We hereby report our method of using a recipient portal vein patch after venoplasty for reconstruction in a right lobe graft with separate anterior and posterior portal vein branches.

关键词： live donor liver transplantation portal vein reconstruction dual portal vein

Asia's first combined liver transplant and aortic valve replacement

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hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 86-87页

作者： chung yeung cheung kenneth s.h.chok oswald j.lee kevin s.lo see ching chan chung mau lo department of surgery queen mary hospitalhong kongChina department of surgery the university of hong konghong kongChina state key laboratory for liver research the university of hong konghong kongChina department of cardiothoracic surgery queen mary hospitalhong kongChina department of anesthesiology queen mary hospitalhong kongChina

To the editor:Liver transplantation is the only cure for patients with endstage liver *** is however an ultra-major surgery which is physiologically challenging to the cardiopulmonary function of the ***,in patients w... 详细信息

关键词： Asia’s first combined liver transplant and aortic valve replacement

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 AFPhieve 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

Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

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hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 329-333页

作者： Julian Tsang Albert Chan kenneth chok Flora Tsang Chung Mau Lo Division of hepatobiliary & Pancreatic surgery and Liver Transplantation Queen Mary Hospital University of Hong Kong Hong Kong China Division of Cardiothoracic surgery Queen Mary Hospital University of Hong Kong Hong Kong China

To the Editor： hepatocellular carcinoma （hCC） remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava （IVC） and right atrium （RA） is an infrequent finding but signifies a pre-terminal event with a dismal prognosis.

关键词： in on as or hCC IVC Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

Emergency re-routing of anterior sector venous outflow for right lobe living donor liver transplantation including the middle hepatic vein

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hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 325-327页

作者： kenneth sh chok see Ching Chan Chung Mau Lo sheung Tat Fan Department of surgery Queen Mary Hospital The University of hong Kong state Key Laboratory for Liver Research

BACKGROUND:Controversy remains over whether the middle hepatic vein should be included in the liver graft in right liver living donor liver *** in the anterior sector of a right liver graft can cause graft malfunction,which is especially devastating in the case of a graft with marginal size in relation to recipient body size on top of poor pre-transplant recipient *** case we report here highlighted the importance of the middle hepatic vein in right liver living donor liver ***:We illustrated the rectification of outflow obstruction of the middle hepatic vein in the anterior sector of right liver graft caused by technical error during *** rectification was performed with emergency re-routing using an artificial ***:Congestion in the anterior sector of the graft improved immediately and the patient’s postoperative liver function test results improved ***:The middle hepatic vein is important for effective drainage of the anterior sector of a right liver *** re-routing technique described in the report can also be applied to cases in which the middle hepatic vein is injured during hepatectomy requiring immediate reconstruction.

关键词： Gore-Tex graft vein graft liver graft cirrhosis hepatitis B infection

Resection of T4 hepatocellular carcinomas with adjacent structures, is it justified？

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hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 52-57页

作者： kenneth sh chok Ka Kin Ng Tan To Cheung Albert CY Chan see Ching Chan Chung Mau Lo Department of surgery The University of Hong Kong

BACKGROUND： T4 hepatocellular carcinoma （hCC） with invasion to adjacent structure（s） may require resection of not only the tumor but also the invaded structure（s）. This study aims to assess whether such combined resection for T4 hCC is justifiable. METhODs： Adult patients with T4 hCC were divided into three groups. Group 1： tumors and invaded adjacent structures were resected together if histopathologically confirmed tumor invasion; group 2： same as group 1 but histopathologically confirmed tumor adhesion; group 3： tumor resection only. Group comparisons were made. REsULTs： Totally 144 patients were included in the study. There were 71, 14 and 59 patients in groups 1, 2 and 3, respec- tively. The groups were comparable in demographics, compli- cation and survival. Ten hospital deaths occurred （5, 0 and 5 in groups 1, 2 and 3, respectively; P=0.533）. The 5-year overall survival （hospital mortality excluded） was 17.8% in group 1, 14.3% in group 2, and 28.9% in group 3 （P=0.191）. The 5-year disease-free survival was 10.4% in group 1 and 14.5% in group 3 （no data for group 2 yet）（P=0.565）. On multivariate analysis, macrovascular invasion and poor differentiation were risk factors for survival whereas combined resection did not impact patients＇ survival. CONCLUsIONs： Combined resection achieved survival outcomes similar to tumor resection only. Patients with tumor invasion and those with tumor adhesion had comparable survival after combined resection. At centers with the required expertise, combined resection should be attempted to treat T4 hCCs with clinically suspected invasion of adjacent structures.

关键词： desmosplastic reaction en-bloc resection hepatocellular carcinoma invasion recurrence

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

Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

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hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 93-98页

作者： Wong hoi she Albert CY Chan Tan To Cheung kenneth sh chok see Ching Chan Ronnie TP Poon Chung Mau Lo Division of hepatobiliary & Pancreatic surgery and Liver Transplantation Department of SurgeryThe University of Hong Kong

BACKGROUND： Acute pancreatitis is a relatively rare but po- tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METhODs： A total of 1632 patients with hepatocellular car- cinoma who had undergone transarterial chemoembolization from ]anuary 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com- plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. REsULTs： Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa- tients was 61 years. Most （79.6%） of the patients suffered from hBV-related hepatoceUular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut- ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. seven （0.4%） patients suffered from acute pancre- atitis post-chemoembolization. six patients had chemoembo- lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxornbicin eluting bead had a higher risk of acute pancreatitis [6/145 （4.1%） vs 1/1487 （0.1%）, P〈0.0001]. Two patients had anatomical arterial variations. Four patients developed acute pancreatitis- related complications including necrotizing pancreatitis （n=3） and pseudocyst formation （n=1）. All of the 4 patients resolved after the use of antibiotics and other conservative treatment. Three patients had further transarterial chemoembolization without any complication. CONCLUsIONs： Acute pancreatitis after transarterial chemo- embolization could result in serious complications, especially after treatment wit

关键词： transarterial chemoembolization acute pancreatitis hepatocellular carcinoma

survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

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hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 256-262页

作者： kenneth sh chok see Ching Chan James YY Fung Tan To Cheung Albert CY Chan sheung Tat Fan Chung Mau Lo Department of surgery The University of Hong Kong state Key Laboratory for Liver Research The University of Hong Kong Department of Medicine The University of Hong Kong

BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METhODs: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score heir demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. REsULTs: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; Phanical ventilation (21.3% vs 0%; Phemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; Ps transfused during operation (7 vs 2 units; Ps stayed longer in the intensive care unit (6 vs 3 days; Phospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. however, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUsIONs: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipi

关键词： Model for End-stage Liver Disease living donor liver transplantation survival right-lobe