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Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

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World Journal of Gastroenterology 2019年第43期25卷 6373-6385页

作者： kin pan au Albert Chi Yan Chan Department of Surgery Queen Mary HospitalHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver *** offers patients with insufficient liver function a chance of a *** is most controversial when its high morbidity and mortality is *** mortality is usually a result of posthepatectomy liver failure and can be minimized with careful patient *** patients have limited reserve for tolerating the demanding *** with colorectal liver metastasis have normal liver and are ideal *** for cholangiocarcinoma is technically challenging and associated with fair *** with hepatocellular carcinoma have chronic liver disease and limited parenchymal ***,in selected patients with limited hepatic fibrosis satisfactory outcomes have been *** the inter-stage period,serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage *** growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II *** outcomes of ALPPS have been improved by a combination of technical *** patients with challenging anatomy,partial ALPPS potentially reduces morbidity,but remnant hypertrophy may compare unfavorably to a complete *** compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation,ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or *** ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy,the long-term outcomes are yet to be determined.

关键词： Associating liver partition with portal vein ligation for staged hepatectomy Two-stage hepatectomy Patient selection Surgical outcomes

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Minimally invasive donor hepatectomy, are we ready for prime time?

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World Journal of Gastroenterology 2018年第25期24卷 2698-2709页

作者： kin pan au 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

Minimally invasive surgery potentially reduces operative morbidities. However, pure laparoscopic approaches to donor hepatectomy have been limited by technical complexity and concerns over donor safety. Reducedwound donor hepatectomy, either in the form of a laparoscopic-assisted technique or by utilizing a minilaparotomy wound, i.e., hybrid approach, has been developed to bridge the transition to pure laparoscopic donor hepatectomy, offering some advantages of minimally invasive surgery. To date, pure laparoscopic donor left lateral sectionectomy has been validated for its safety and advantages and has become the standard in experienced centres. Pure laparoscopic approaches to major left and right liver donation have been reported for their technical feasibility in expert hands. Robotic-assisted donor hepatectomy also appears to be a valuable alternative to pure laparoscopic donor hepatectomy, providing additional ergonomic advantages to the surgeon. Existing reports derive from centres with tremendous experience in both laparoscopic hepatectomy and donor hepatectomy. The complexity of these procedures means an arduous transition from technical feasibility to reproducibility. Donor safety is paramount in living donor liver transplantation. Careful donor selection and adopting standardized techniques allow experienced transplant surgeons to safely accumulate experience and acquire proficiency. An international prospective registry will advance the understanding for the role and safety of pure laparoscopic donor hepatectomy.

关键词： laparoscopic donor hepatectomy living donor liver transplantation minimally invasive surgery

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Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm

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World Journal of Gastroenterology 2018年第45期24卷 5081-5094页

作者： kin pan au 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

A large number of liver transplants have been performed for hepatocellular carcinoma(HCC), and recurrence is increasingly encountered. The recurrence of HCC after liver transplantation is notoriously difficult to manage. We hereby propose multi-disciplinary management with a systematic approach. The patient is jointly managed by the transplant surgeon, physician, oncologist and radiologist. Immunosuppressants should be tapered to the lowest effective dose to protect against rejection. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor could be considered with close monitoring of graft function and toxicity. Comprehensive staging can be performed by dual-tracer positron emission tomography-computed tomography or the combination of contrast computed tomography and a bone scan. In patients with disseminated recurrence, sorafenib confers survival benefits but is associated with significant drug toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic recurrence can be managed with graft resection, but significant operative morbidity is expected. Radiofrequency ablation and stereotactic body radiation therapy(SBRT) are effective alternative strategies. In patients with more advanced hepatic disease, regional treatment with trans-arterial chemoembolization or intra-arterial Yttrium-90 can be considered. For patients with extra-hepatic oligorecurrence, loco-regional treatment can be considered if practical. Patients with more than one site of recurrence are not always contraindicated for curative treatments. Surgical resection is effective for patients with pulmonary oligo-recurrence, but adequate lung function is a prerequisite. SBRT is a non-invasive and effective modality that conveys local control to pulmonary and skeletal oligo-recurrences.

关键词： Hepatocellular carcinoma Recurrence Liver transplantation

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Confounders in developing a machine learning model for colorectal liver metastasis post-hepatectomy prognostications

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Hepatobiliary Surgery and Nutrition 2024年第2期13卷 389-390页

作者： kin pan au Tan To Cheung Department of Surgery School of Clinical MedicineLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina

We extend our gratitude to *** and colleagues for their valuable feedback and comments on our article(1).We developed a machine learning model which predicted the outcomes of surgical treatment for colorectal liver metastasis(CRLM)with good discriminative *** analyzing the data,we found that patients who underwent neoadjuvant chemotherapy before resection had lower rates of overall survival and disease-free *** agree that the negative impact of neoadjuvant chemotherapy on survival is probably a confounding factor due to a more advanced disease status at the time of *** is supported by our data,which show that patients who received neoadjuvant therapy were more likely to have had bilobar liver metastasis(45.2%vs.23.3%,P<0.001)and multiple liver lesions(64.9%vs.42.3%,P<0.001)when compared to those who underwent upfront hepatectomy.

关键词： metastasis chemotherapy colorectal

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Surgical cystogastrostomy: Is it still worthwhile?

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World Journal of Gastroenterology 2024年第17期30卷 2298-2301页

作者： kin pan au Kenneth Siu Ho Chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong Kong 999077China Department of Surgery The Chinese University of Hong KongHong Kong 999077China

The article by Ker et al explores the treatment of peripancreatic fluid collection(PFC).The use of percutaneous drainage,endoscopy,and surgery for managing PFC are *** drainage is noted for its low risk profile,while endoscopic cystogastrostomy is more effective due to the wider orifice of the metallic *** cystogastrostomy is a definitive treatment with a reduced need for reintervention,especially for cases with extensive collections and significant *** choice of treatment modality should be tailored to individual patient characteristics and disease factors,considering the expertise available.

关键词： Endoscopic cystgastrostomy Surgical cystgastrostomy pancreatitis pancreatic necrosis Peripancreatic collection

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Mammalian target of rapamycin inhibitors after post-transplant hepatocellular carcinoma recurrence:Is it too late?

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World Journal of Gastrointestinal Surgery 2020年第4期12卷 149-158页

作者： kin pan au Kenneth Siu Ho Chok Department of Surgery Queen Mary HospitalHong Kong 999077China Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong Kong 999077China

BACKGROUND Mammalian target of rapamycin(mTOR)inhibitors have been shown to reduce the risk of tumour recurrence after liver transplantation for hepatocellular carcinoma(HCC).However,their role in established post-transplant HCC recurrence is *** To investigate whether mTOR inhibitor offers a survival benefit in posttransplant HCC *** A retrospective study of 143 patients who developed HCC recurrence after liver transplantation was *** were divided into 2 groups based on whether they had received mTOR inhibitor-based *** primary endpoint was post-recurrence *** Seventy-nine(55%)patients received an mTOR inhibitor-based immunosuppressive regime,while 64(45%)patients did *** mTOR inhibitor group had a lower number of recurrent tumours(2 vs 5,P=0.02)and received more active treatments including radiotherapy(39 vs 22%,P=0.03)and targeted therapy(59 vs 23%,P<0.001).The median post-recurrence survival was 21.0±4.1 mo in the mTOR inhibitor group and 11.2±2.5 mo in the control *** Cox regression analysis confirmed that mTOR inhibitor therapy was independently associated with improved post-recurrence survival(P=0.04,OR=0.482,95%CI:0.241-0.966).The number of recurrent tumours and use of other treatment modalities did not affect *** survival difference was observed between mTOR inhibitor monotherapy and combination therapy with calcineurin *** mTOR inhibitors prolonged survival after post-transplant HCC recurrence.

关键词： Mammalian target of rapamycin inhibitor Hepatocellular carcinoma Recurrence Liver transplant Survival Outcomes

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Immunotherapy after liver transplantation:Where are we now?

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1267-1278页

作者： kin pan au Kenneth Siu Ho Chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong KongChina Department of Surgery and State Key Laboratory for Liver Research The University of Hong KongHong KongChina

BACKGROUND There is limited evidence on the safety of immunotherapy use after liver transplantation and its efficacy in treating post-liver transplant hepatocellular carcinoma(HCC)*** To assess the safety of immunotherapy after liver transplant and its efficacy in treating post-liver transplant HCC *** A literature review was performed to identify patients with prior liver transplantation and subsequent *** reviewed the rejection rate and risk factors of *** patients treated for HCC,the oncological outcomes were evaluated including objective response rate,progression-free survival(PFS),and overall survival(OS).RESULTS We identified 25 patients from 16 publications and 3 patients from our institutional database(total n=28).The rejection rate was 32%(n=9).Early mortality occurred in 21%(n=6)and was mostly related to acute rejection(18%,n=5).Patients who developed acute rejection were given immunotherapy earlier after transplantation(median 2.9 years vs 5.3 years,P=0.02)and their graft biopsies might be more frequently programmed death ligand-1-positive(100%vs 33%,P=0.053).Their PFS(1.0±0.1 mo vs 3.5±1.1 mo,P=0.02)and OS(1.0±0.1 mo vs 19.2±5.5 mo,P=0.001)compared inferiorly to patients without *** the 19 patients treated for HCC,the rejection rate was 32%(n=6)and the overall objective response rate was 11%.The median PFS and OS were 2.5±1.0 mo and 7.3±2.7 mo after *** Rejection risk is the major obstacle to immunotherapy use in liver transplant *** studies on the potential risk factors of rejection are warranted.

关键词： Liver transplant Hepatocellular carcinoma Recurrence Immunotherapy Rejection Survival

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Hepatectomy bridges to transplant—the road to cure?

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Hepatobiliary Surgery and Nutrition 2019年第1期8卷 72-73页

作者： kin pan au Kenneth Siu Ho Chok Department of Surgery The University of Hong KongHong KongChina

Liver transplantation and hepatic resection are effective surgical strategies for hepatocellular carcinoma(HCC).In the current issue of Annals of Surgery,Professor Pinna and colleagues applied a cure model to compare both treatments(1).Comparison was made in terms of cure ***,curation has never been concisely defined in clinical *** the standard survival model,patients are considered disease-free after R0 resection but are always at risk of *** is arguable,particularly for HCC,whether disease clearance equates curation,as more than half of patients recur in 5 years after radical resection(2).In epidemiology,statistical cure is achieved when the mortality of the patients treated for a specific disease return to that in the general population(3).However,statistical cure is neither practical in clinical sense,as patients surviving with disease are also considered cured.

关键词： Surgery epidemiology mortality

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Inferior vena cava reconstruction in extended right hepatectomy

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Hepatobiliary & pancreatic Diseases International 2024年第5期23卷 533-534页

作者： Karin KY Ho Sui Ling Sin kin pan au Henry HY Lee Daniel TL Chan Albert Chan Department of Surgery The University of Hong Kong102 Pok Fu Lam RoadHong KongChina Department of Surgery Yan Chai Hospital7 Yan Chai StreetHong KongChina State Key Laboratory of Liver Research(Li Ka Shing Faculty of Medicine The University of Hong Kong)102 Pok Fu Lam RoadHong KongChina

To the Editor : Barcelona Clinic Liver Cancer(BCLC) Stage C hepatocellular carcinoma(HCC) with vascular invasion has been considered unresectable. However, the curative rate from systemic treatment is rather dismal. Even with the use of immunotherapy, complete remission is less than 10% [ 1 ]. On the contrary, recent advances in transplant oncology, especially in the application of liver transplant-related surgical techniques in complex liver resections, make the operation possible for patients with locally advanced HCC who were previously considered to be unresectable [ 2 ]. We hereby present the surgical management of a patient with giant HCC in right liver lobe with inferior vena cava(IVC) invasion.

关键词： invasion vena Liver

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Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation

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World Journal of Clinical Cases 2020年第13期8卷 2758-2768页

作者： kin pan au Chi Leung Chiang Albert Chi Yan Chan Tan To Cheung Chung Mau Lo Kenneth Siu Ho Chok Department of Surgery Queen Mary HospitalThe University of Hong KongHong Kong 999077China Department of Clinical Oncology Queen Mary Hospitalthe University of Hong KongHong Kong 999077China

BACKGROUND Graft hepatocellular carcinoma(HCC)recurrence after liver transplant is more frequently *** hepatectomy is technically challenging and is associated with high *** body radiation therapy(SBRT)has been shown to be safe and effective for the treatment of primary ***,its role in HCC recurrence in a liver graft remains *** To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver *** A retrospective study was *** 2012 to 2018,6 patients with intrahepatic HCC recurrence after liver transplant were treated with SBRT at Queen Mary Hospital,the University of Hong *** primary outcome was time to overall disease progression and secondary outcomes were time to local progression and best local response,as assessed with the Modified response Evaluation Criteria for Solid Tumours *** were monitored for treatment related toxicities and graft *** A total of 9 treatment courses were given for 13 *** median tumour size was 2.3 cm(range 0.7-3.6 cm).Two(22%)patients had inferior vena cava tumour *** best local treatment response was:5(55%)complete response,1(11%)partial response and 3(33%)stable *** a median follow up duration of 15.5 mo,no local progression or mortality was yet *** median time to overall disease progression was 6.5 *** were 6 regional progression in the liver graft(67%)and 2 distant progression in the lung(22%).There was no grade 3 or above toxicity and there was no graft dysfunction after *** SBRT appears to be safe in this *** progression is the mode of failure.

关键词： Stereotactic body radiotherapy Hepatocellular carcinoma Liver transplantation Recurrence Radiosurgery Outcomes

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