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Current controversies and challenges for resection of pancreatic ductal adenocarcinoma in pancreatic head aiming at cure

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Hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 111-112页

作者： wan yee lau Faculty of Medicine the Chinese University of Hong KongPrince of Wales HospitalShatinHong Kong SARChina

Pancreatic ductal adenocarcinoma(PDAC) is a very common but a highly lethal malignancy due to its biological aggressive behavior. PDAC more commonly affects the head than other parts of the pancreas. As PDAC in the head of pancreas is located at an anatomical position with a lot of adjacent vital structures, and the cornerstone of treatment aiming at cure is pancreaticoduodenectomy(PD).

关键词： adenocarcinoma ductal pancreas

Reply to the commentary on “The efficiency of pathological response after preoperative transcatheter arterial chemoembolization for microvascular invasion and early tumor recurrence in hepatocellular carcinoma”

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Hepatobiliary Surgery and Nutrition 2023年第1期12卷 144-147页

作者： Yun Yang Weiping Zhou wan yee lau Eastern Hepatobiliary Surgery Hospital ShanghaiChina Faculty of Medicine The Chinese University of Hong KongHong KongChina

We thank He et al.for their interest in our recent article(1)and for their thoughtful comments.The first question raised by He et al.is on the total number of patients in the PSM cohort in Table 1,which they considered incorrect.In this study,we first analyzed the incidences of MVI in the groups of patients with or without preoperative TACE.Before PSM,there were 737 patients who received preoperative TACE,and 1,233 patients who did not receive preoperative TACE.

关键词： preoperative invasion

Early control of short hepatic portal veins in isolated or combined hepatic caudate lobectomy

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 377-382页

作者： wan-yee lau Faculty of Medicine The Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND:Caudate lobectomy has long been considered technically difficult.This study aimed to elaborate the significance of early control of short hepatic portal veins(SHPVs) in isolated hepatic caudate lobectomy or in hepatic caudate lobectomy combined with major partial hepatectomy,and to describe the anatomical characteristics of SHPVs.METHODS:The data of 117 patients who underwent either isolated or combined caudate lobectomy by the same team of surgeons from 2005 to 2009 were retrospectively analyzed.From 2005 to 2007(group A,n=55),we carried out early control of short hepatic veins(SHVs) only;from 2008 to 2009(group B,n=62),we carried out early control of both SHVs and SHPVs.The two groups were compared to evaluate which surgical procedure was better.A detailed anatomical study was then carried out on the last 25 consecutive patients in group B to study the number and distribution of SHPVs during surgery.RESULTS:Patients in group B had less intra-operative blood loss,less impairment of liver function,shorter postoperative hospital stay,fewer postoperative complications and required less blood transfusion(P<0.05).The number of SHPVs in the 25 patients was 183,with 7.3±2.7 per patient.The diameters of SHPVs were 1 to 4 mm.On average,3.4 SHPVs/patient came from the left portal vein,2.2 from the bifurcation,1.4 from the right portal vein,and 0.3 from the main portal vein.On average,3.3 SHPVs/patient supplied segment I of the liver,0.4 for segment II,2.1 for segment IV,1.4 for segment V and 0.1 for segment VI.CONCLUSION:Early control of SHPVs in isolated or combined hepatic caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery.

关键词： short hepatic portal vein caudate lobe anatomy

Modified conventional clamp-crushing technique in liver parenchymal transection

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 442-445页

作者： wan-yee lau Faculty of Medicine The Chinese University of Hong KongShatinHong Kong SARChina

Significant intraoperative bleeding and injuries to vital structures in the liver remnant can occur during liver parenchymal transection using the conventional clampcrushing technique.We performed liver resection on 242 patients using a mosquito clamp-crushing technique combined with a self-assembled saline-linked diathermy for liver parenchymal transection.The mean blood loss was 215 mL(range 20-1100).There was no damage to the vital structures in the liver remnant.The mean liver transection time was 53 minutes(range 15-125).Our technique has the advantages of reducing blood loss,exposing vessles clearly and being simple,cheap and efficacious.

关键词： hepatectomy hepatocellular carcinoma liver neoplasm

A novel chemotherapy strategy for advanced hepatocellular carcinoma: a multicenter retrospective study

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Chinese Medical Journal 2022年第19期135卷 2338-2343页

作者： Juxian Sun Chang Liu Jie Shi Nanya wang Dafeng Jiang Feifei Mao Jingwen Gu Liping Zhou Li Shen wan yee lau Shuqun Cheng Department of Hepatic Surgery VI Eastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityShanghai 200433China Department of Integrative Oncology Eastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityShanghai 200433China Department of Outpatient Department Eastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityShanghai 200433China Department of Oncology First Hospital of Jlin UniversityChangchunJlin 1300China Department of Oncology Zhejiang Sian International Hospital JiaxingZhejang 314000China Tongji University Cancer Center Shanghai Tenth People's HospitaSchool of MedicineTongji UniversitShanghai 200040China Faculty of Medicine The Chinese University of Hong KongPrince of Wales HospitalShatinNew TerritoriesHong Kong SAR 999077China.

Background:Chemotherapy is a common treatment for advanced hepatocellular carcinoma,but the effect is not satisfactory.The study aimed to retrospectively evaluate the effects of adding all-trans-retinoic acid(ATRA)to infusional fluorouracil,leucovorin,and oxaliplatin(FOLFOX4)for advanced hepatocellular carcinoma(HCC).Methods:We extracted the data of patients with advanced HCC who underwent systemic chemotherapy using FOLFOX4 or ATRA plus FOLFOX4 at the Eastern Hepatobiliary Surgery Hospital,First Hospital of Jilin University,and Zhejiang Sian International Hospital and retrospectively compared for overall survival.The Cox proportional hazards model was used to calculate the hazard ratios for overall survival and disease progression after controlling for age,sex,and disease stage.Results:From July 2013 to July 2018,111 patients with HCC were included in this study.The median survival duration was 14.8 months in the ATRA plus FOLFOX4 group and 8.2 months in the FOLFOX4 only group(P<0.001).The ATRA plus FOLFOX4 group had a significantly longer median time to progression compared with the FOLFOX4 group(3.6 monthsvs.1.8 months,P<0.001).Hazard ratios for overall survival and disease progression were 0.465(95%confidence interval:0.298–0.726;P=0.001)and 0.474(0.314–0.717;P<0.001)after adjusting for potential confounders,respectively.Conclusion:ATRA plus FOLFOX4 significantly improves the overall survival and time to disease progression in patients with advanced HCC.

关键词： Hepatocellular carcinoma ATRA plus FOLFOX4 Overall survival All-trans-retinoic acid Fluorouracil Leucovorin Oxaliplatin

Impact of pathological response after preoperative transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma:a multicenter propensity score matching analysis

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 386-399页

作者： Yun Yang Zheng Dang Peng Lu Youwen Qian Kongying Lin Zeya Pan wan yee lau Weiping Zhou The Third Department of Hepatic Surgery Eastern Hepatobiliary Surgery HospitalShanghaiChina Department of Hepatobiliary Surgery 940 Hospital of PLA Joint Logistic Support ForceLanzhouChina Department of Hepatobiliary Surgery Hainan Hospital of Chinese PLA General HospitalSanyaChina Department of Pathology Eastern Hepatobiliary Surgery HospitalShanghaiChina Department of Hepatopancreatobiliary Surgery Mengchao Hepatobiliary Hospital of Fujian Medical UniversityFuzhouChina Faculty of Medicine the Chinese University of Hong KongHong KongChina Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer(SMMU) Ministry of EducationShanghaiChina Shanghai Key Laboratory of Hepatobiliary Tumor Biology(EHBH) ShanghaiChina

Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patients.Methods:Between 2013 to 2015,consecutive HCC patients who underwent liver resection with“curative”intent at three hospitals were enrolled in this study.Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI,early recurrence rates and patterns of recurrence before and after propensity score matching(PSM).Results:Of 1,970 patients,737 patients who received preoperative TACE were divided into three groups according to the areas of PR:≥90%(n=226),60-90%(n=447),and<60%(n=64).PR≥90%was an independent protective factor of incidences of MVI[odds ratio(OR),0.144;95%confidence interval(CI),0.082-0.245,P<0.001)and early recurrence(HR,0.742;95%CI,0.561-0.963,P=0.032);while PR<60%was an independent risk factor of incidences of MVI(OR,6.076;95%CI,3.004-11.728,P<0.001)and early recurrence(HR,1.428;95%CI,1.095-1.929;P=0.009).Furthermore,patients with PR<60%were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions:This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence.Patients with PR<60%were at significantly higher risks of having more MVI,early and multiple tumor recurrences.

关键词： Hepatocellular carcinoma(HCC) transcatheter arterial chemoembolization(TACE) pathological response microvascular invasion(MVI) early recurrence

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

Novel liver vein deprivation technique that promotes increased residual liver volume(with video):A case report

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World Journal of Clinical Cases 2022年第31期10卷 11579-11584页

作者： Gang Wu Ji-Peng Jiang Dong-Hui Cheng Chong Yang Dong-Xu Liao Yu-Bo Liao wan-yee lau Yu Zhang Department of Hepatobiliary Surgery Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Organ Transplantation Center Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Faculty of Medicine The Chinese University of Hong KongPrince of Wales HospitalHongkong 999077China

BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver tumors.As an alternative to associating liver partition and portal vein ligation(ALPPS)for staged hepatectomy and liver venous deprivation(LVD)using stage 1 interventional radiology for vascular embolization combined with stage 2 open liver resection have been used.CASE SUMMARY A novel modified LVD technique was performed in a patient with pancreatic neuroendocrine tumor with liver metastases by using stage 1 laparoscopic ligation of the right hepatic vein,right posterior portal vein,and short hepatic veins combined with local excision of three liver metastases in the left hemiliver.The operation was followed three days later by interventional radiology to embolize an anomalous right anterior portal vein to complete LVD.A stage 2 laparoscopic right hemihepatectomy and pancreaticosplenectomy were then carried out.CONCLUSION The minimally invasive technique promoted a rapid increase,comparable to ALPPS,in volume of the FLR after the stage 1 operation to allow the laparoscopic stage 2 resection to be performed.

关键词： Laparoscopic Liver venous deprivation Future liver remnant Case report

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 the reported preliminary results, safety of the AL

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