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Classification of iatrogenic bile duct injury

Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 459-463页

作者： wan-yee lau Eric C.H.Lai Department of Surgery the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.

关键词： laparoscopic cholecystectomy bile duct injury bile duct stricture bile leak classification

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Creating favorable conditions for increased quantity of high-quality clinical studies in surgery

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Hepatobiliary Surgery and Nutrition 2020年第3期9卷 330-332页

作者： Tian Yang wan yee lau Feng Shen Department of Hepatic Surgery The Eastern Hepatobiliary Surgery HospitalSecond Military Medical University(Naval Medical University)Shanghai 200438China Faculty of Medicine The Chinese University of Hong KongHong KongSARChina

Nowadays,surgeons in China,especially those who are working in teaching hospitals affiliated to universities,concentrate their research efforts in basic researches mainly because these researches can generate scientific articles in journals of high impact factors which are essential for career advancement,job promotion and securing research grants.

关键词： teaching promotion curing

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Hepatocellular carcinoma: current management and recent advances

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Hepatobiliary & Pancreatic Diseases International 2008年第3期7卷 237-257页

作者： wan-yee lau Eric C. H. Lai Faculty of Medicine The Chinese University of Hong Kong Prince of Wales Hospital Shatin New Territories Hong Kong SAR China

BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth most common cancer in the world, and the third most common cause of cancer-related death. Without specific treatment, the prognosis is very poor. The goal of management is 'cancer control'-a reduction in its incidence and mortality as well as an improvement in the quality of life of patients with HCC and their families. This article aims to review the current management of HCC and its recent advances. DATA SOURCES: A MEDLINE database search was performed to identify relevant article using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'liver transplantation', and 'local ablative therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Liver resection and liver transplantation remain the options that give the best chance of a cure. Recent evidence suggests that local ablative therapy may offer comparable survival results in patients with small HCC, and preserved liver function. Transarterial chemoembolization (TACE) is the most promising palliative modality for unresectable HCC, but other techniques, such as transarterial radioembolization (TARE), and local ablative therapy, have also shown comparable results. CONCLUSIONS: Early diagnosis of HCC remains a key goal in improving the prognosis of patients. During the last two decades, operative mortality and surgical outcome of liver resection and liver transplantation for HCC have improved. Progress also has been made in multi-modality therapy which can increase the chance of survival and improve the quality of life for patients with advanced HCC.

关键词： hepatocellular carcinoma hepatectomy liver transplantation local ablative therapy

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Development and controversies of adjuvant therapy for pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 121-125页

作者： wan-yee lau Eric C.H.Lai Faculty of Medicine the Chinese University of Hong Kong Prince of Wales Hospital Shatin New TerritoriesHong Kong SAR China

BACKGROUND: Pancreatic cancer is an aggressive malignancy with a dismal prognosis. Radical surgery provides the only chance for a cure with a 5-year survival rate of 7%-25%. An effective adjuvant therapy is urgently needed to improve the surgical outcome. This review describes the current status of adjuvant therapy for pancreatic cancer, and highlights its controversies. DATA SOURCES: A Medline database search was performed to identify relevant articles using the keywords 'pancreatic neoplasm', and 'adjuvant therapy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Eight prospective randomized controlled trials (RCTs) on the use of adjuvant chemotherapy and chemoradiation for pancreatic cancer could be identified. The results for adjuvant regimens based on systemic 5-fluorouracil with or without external radiotherapy were conflicting. The recent two RCTs on gemcitabine based regimen gave promising results. CONCLUSIONS: Based on the available data, no standard adjuvant therapy for pancreatic cancer can be established yet. The best adjuvant regimen remains to be determined in large-scale RCTs. Future trials should use a gemcitabine based regimen.

关键词： pancreatic neoplasm pancreatectomy adjuvant therapy radiotherapy chemotherapy

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Methods of vascular control technique during liver resection:a comprehensive review

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 473-481页

作者： wan-yee lau Eric C.H.Lai Stephanie H.Y.lau Faculty of Medicine the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had

关键词： vascular control vascular exclusion hepatectomy liver neoplasm Pringle maneuver

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

关键词： preoperative invasion

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The current role of neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hepatocellular carcinoma:a systematic review

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Hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 124-133页

作者： wan-yee lau Eric C.H.Lai Stephanie H.Y.lau State Key Laboratory for Diagnosis and Treatment of Infectious Diseases First Affiliated HospitalZhejiang University School of Medicine

BACKGROUND: Following curative treatment for hepatocellular carcinoma (HCC), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any neoadjuvant or adjuvant therapy, which can decrease or delay the incidence of intra-hepatic recurrence, or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant, will improve the results of liver resection. This article systematically reviewed the current evidence of neoadjuvant, adjuvant, and chemoprevention in partial hepatectomy of HCC. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'adjuvant therapy', 'neoadjuvant therapy', and 'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with (131)I-lipiodol and adjuvant systemic interferon showed promising results. However, there were only a limited number of such studies. CONCLUSIONS: Further randomized controlled studies need to be carried out. Currently, there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC.

关键词： hepatocellular carcinoma hepatectomy adjuvant therapy neoadjuvant therapy therapeutic embolization

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A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum

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Frontiers of Medicine 2015年第1期9卷 108-111页

作者： Eric C.H. Lai Kam Man Chung Stephanie H.Y. lau wan yee lau Faculty of Medicine The Chinese University of Hong Kong Shatin Hong Kong SAR China Dr. K.M. Chung's Clinic Rm 807 Hang Seng Tsimshatsui Building 18 Carnarvon Road Tsimshatsui Hong Kong SAR China Department of Surgery Pamela Youde Nethersole Eastern Hospital Hong Kong SAR China Department of Surgery Queen Elizabeth Hospital Hong Kong SAR China

Hemoperitoneum is a rare and potentially life-threatening complication of GIST. We reported a 54- year-old man who developed disseminated intra-abdominal recurrence from a previously resected gastrointestinal stromal tumour （GIST） of the small bowel, and the patient presented with hemoperitoneum. Emergent debulking surgery was performed. A high dose imatinib was prescribed. Despite the presence of residual disease, the patient was well clinically 8 months after the operation. Even though, there is no evidence to support the routine use of debulking surgery in the management of GIST. In our patient, disease progression after second line targeted therapy and the absence of alternative treatment options for spontaneous rupture and hemoperitoneum prompted us to treat the patient aggressively. Resection of the ruptured GIST was carried out for control of bleeding and to prevent recurrent bleeding in this patient with good surgical risks. During the treatment decision-making, the patient＇s general condition, the risk of surgery and the extent of dissemination were taken into consideration. In this patient who presented with spontaneous rupture of a small intestinal GIST, the novel use of targeted therapy and aggressive surgical treatment produced reasonably good survival outcome.

关键词： gastrointestinal stromal tumour hemoperitoneum small bowel GIST small bowel neoplasm imatinib

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Loco-regional intervention for hepatocellular carcinoma

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Journal of Interventional Medicine 2019年第2期2卷 43-46页

作者： wan yee lau Eric C.H.Lai Faculty of Medicine The Chinese University of Hong KongNew TerritoriesHong KongChina

Anatomic location/size and number of lesions,inadequate volume of future liver remnant,or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma(HCC).Liver transplantation can cure some patients with poor liver function,but few patients are eligible because of scarcity of *** specific anti-cancer treatment,the prognosis of HCC is *** locoregional therapies are used to treat patients who are not candidates for surgery,and have emerged as tools for palliation,tumor downstaging,and bridging therapy prior to liver ***,local ablative therapy even competes with partial hepatectomy and liver transplantation as a primary treatment for small *** is well suited to treatment with loco-regional therapy because it has a tendency to stay within the liver,with distant metastasis generally occurring late in the course of *** suggests that an effective local-regional therapy can have a great impact on HCC patients who are not candidates for surgical ***-regional therapy can further be justified because patients with HCC usually die of liver failure consequent to intrahepatic growth resulting in liver tissue destruction,rather than extrahepatic metastases.

关键词： Hepatocellular carcinoma Hepatectomy Loco-regional therapy TACE Local ablation

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Intrahepatic Glissonian approach and outflow vascular occlusion during partial hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 101-104页

作者： Feng Xia Guo Li wan-yee lau Kuan-Sheng Ma Ping Bie Institute of Hepatobiliary Surgery Southwest HospitalSouthwest Cancer Center Third Military Medical University Faculty of Medicine the Chinese University of Hong Kong

Under ultrasound guidance, a blunt suture needle was inserted around the Glissonian pedicle and then sutured. This technique significantly reduced the blood loss and facilitated the procedure of partial hepatectomy. We applied this technique in 182 patients who needed partial hepatectomy. We concluded that this method is simple and easy to occlude the vascular inflow and outflow, and allows an accurate delineation of the anatomic zone and therefore, simplifies the procedure of partial hepatectomy.

关键词： hepatectomy the Glissonian approach blunt needle surgical technique

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