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Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

World Journal of Gastrointestinal Surgery 2024年第3期16卷 777-789页

作者： Kai Siang Chan Biquan Liu Ming Ngan Aloysius tan Kwang Yeong How Kar Yong Wong Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality *** 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on *** LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical *** and/or PE is a major and complex surgery with high post-operative *** invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic *** is a single-center retrospective cohort study from 1st January 2015 to 31st March *** criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic ***-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also *** criteria were patients with systemic metastases with non-resectable *** patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal *** sur-gery was defined based on technical difficulty of surgery(*** PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication ***-gorical values were described as percentages and analysed by the chi-square *** variables were expressed as median(range)and analysed by Mann-Whitney U *** overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table ***-rank test was performed to determine statistical significance between cumulative *** significance was defined as P<*** estimates with li

关键词： Laparoscopy Minimally invasive surgical procedures Multivisceral resection Pelvic Exenteration Rectal neoplasms Robotic surgical procedures

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Improving clinical outcomes of patients with hepatocellular carcinoma:Role of antiviral therapy,conversion therapy,and palliative therapy

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World Journal of Gastrointestinal Oncology 2024年第10期16卷 4037-4041页

作者： Vishal G Shelat Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

In this editorial,I comment on three articles published in the recent issue of the World Journal of Gastrointestinal *** carcinoma(HCC)is an important public health concern,and there are three articles on the theme of HCC in this issue.I focus on the articles by Mu et al,Chu et al,and Ma et al for this *** these articles may be considered as low-quality evidence,and the results cannot be generalized to non-hepatitis-B or C virus patients,the discussion of the results is *** addition,though all the articles are from China,the relevance of the results is not *** resection is the main form of curative treatment modality owing to a donor liver shortage,surgeons need to be aware that preoperative long-course antiviral therapy can improve clinical outcomes by reducing postoperative liver dysfunction and recurrence of HCC following ***,patients with super-giant HCC(defined as≥15 cm diameter)should also be carefully considered for liver resection,and if it is unresectable upfront,then a combination of liver-directed therapy and systemic therapy may downstage ***,following downstaging,the patient qualifies for liver resection based on locally prevalent resectability criteria,then such therapy is labelled as conversion(from unresectable to resectable)*** unresectable patients treated by a combination of treatment options,serological markers like neutrophil-to-lymphocyte ratio and alpha-fetoprotein are reported to predict treatment responses,thus enabling personalized medicine.

关键词： Antivirals Chemoembolization Conversion therapy Hepatocellular carcinoma Lenvatinib Neutrophil-to-lymphocyte ratio

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Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

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Asian Journal of Urology 2024年第2期11卷 324-330页

作者： Ee Jean Lim Zhen Wei Choo Reshma Mangat Pradeep Durai Sarvajit Biligere Yiquan tan Loh Hin Yeung Marcus Nicole Andrea Seet Li Ting Chin Tiong Heng Stefania Ferreti Vineet Gauhar Urology Department Singapore General HospitalSingapore Urology Department Tan Tock Seng HospitalSingapore Urology Department Ng Teng Fong HospitalSingapore Urology Department Azienda Ospedaliera-Uiversitaria(Hospital and University of Parma)ParmaItaly

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal *** is believed that lesser stent material within the bladder mitigates stent-related *** study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal ***:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were *** compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at ***:Both groups had similar median age,distribution in male to female ratio,and stone *** overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at *** groups had similar ease in insertion with no hospital ***:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related *** showed a good safety profile with easy deployment and *** promises a new standard in stenting.

关键词： Stent Ureteroscopy Pigtail suture stent Asianpatient Flexible ureteroscopic renal surgery

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Ethical frontiers in liver transplantation

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World Journal of Transplantation 2024年第4期14卷 50-60页

作者： Hoi Pong Nicholas Wong Surya Varma Selvakumar Pei Yi Loh Jovan Yi Jun Liau Matthias Yi Quan Liau Vishalkumar Girishchandra Shelat Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Surgical Science Training Centre Tan Tock Seng HospitalSingapore 308433Singapore

Liver transplantation represents a pivotal intervention in the management of end-stage liver disease,offering a lifeline to countless *** significant strides in surgical techniques and organ procurement,ethical dilemmas and de-bates continue to underscore this life-saving *** the ethical terrain surrounding this complex procedure is hence *** the nuances of ethical principles of justice,autonomy and beneficence that underpin transplant protocols worldwide,we explore the modern challenges that plaques the world of liver *** investigate the ethical dimensions of organ transplantation,focusing on allocation,emerging technologies,and decision-making ***,Scopus,Web of Science,Embase and Central were searched from database inception to February 29,2024 using the following key-words:“liver transplant”,“transplantation”,“liver donation”,“liver recipient”,“organ donation”and“ethics”.Information from relevant articles surrounding ethical discussions in the realm of liver transplantation,especially with regards to organ recipients and allocation,organ donation,transplant tourism,new age technologies and developments,were *** the definition of death to the long term follow up of organ recipients,liver transplantation has many ethical *** new transplant techniques,societal acceptance and perceptions also play a pivotal ***,religious and regional factors including but not limited to beliefs,wealth and accessibility are extremely influential in public at-titudes towards donation,xenotransplantation,stem cell research,and adopting artificial *** and addressing these perspectives whilst upholding bioethical principles is essential to ensure just distribution and fair allocation of *** regulatory oversight for ethical sourcing of organs,ensuring good patient selection and transplant techniques,and high-quality long-term surveillance to mitiga

关键词： “liver transplant” “transplan-tation” “liver donation” “liver recipient” “organ donation”and“ethics”

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Outcomes of liver resection in hepatitis C virus-related intrahepatic cholangiocarcinoma:A systematic review and meta-analysis

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World Journal of Virology 2024年第1期13卷 107-119页

作者： Feng Yi Cheo Kai Siang Chan Vishal G Shelat Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Cholangiocarcinoma is the second most common primary liver *** incidence and mortality rates have been increasing in recent *** C virus(HCV)infection is a risk factor for development of cirrhosis and ***,surgical resection remains the only curative treatment option for *** aim to study the impact of HCV infection on outcomes of liver resection(LR)in intrahepatic cholangiocarcinoma(ICC).AIM To study the outcomes of curative resection of ICC in patients with HCV(i.e.,HCV+)compared to patients without HCV(i.e.,HCV-).METHODS We conducted a systematic review and meta-analysis of randomized controlled trials(RCTs)and observational studies to assess the outcomes of LR in ICC in HCV+patients compared to HCV-patients in tertiary care ***,EMBASE,The Cochrane Library and Scopus were systematically searched from inception till August *** studies were RCTs and non-RCTs on patients≥18 years old with a diagnosis of ICC who underwent LR,and compared outcomes between patients with HCV+vs HCV-.The primary outcomes were overall survival(OS)and recurrence-free *** outcomes include perioperative mortality,operation duration,blood loss,intrahepatic and extrahepatic *** Seven articles,published between 2004 and 2021,fulfilled the selection *** of the studies were retrospective ***,incidence of male patients,albumin,bilirubin,platelets,tumor size,incidence of multiple tumors,vascular invasion,bile duct invasion,lymph node metastases,and stage 4 disease were comparable between HCV+and *** transaminase[MD 22.20,95%confidence interval(CI):13.75,30.65,P<0.00001]and aspartate transaminase levels(MD 27.27,95%CI:20.20,34.34,P<0.00001)were significantly higher in HCV+group compared to *** of cirrhosis was significantly higher in HCV+group[odds ratio(OR)5.78,95%CI:1.38,24.14,P=0.02]compared to *** of poorly

关键词： Cholangiocarcinoma Bile duct cancer Hepatitis C Surgical resection Hepatectomy

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Pancreatic pseudocyst:The past,the present,and the future

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1986-2002页

作者： Jonathan GA Koo Matthias Yi Quan Liau Igor A Kryvoruchko Tamer AAM Habeeb Christopher Chia Vishal G Shelat Department of General Surgery Khoo Teck Puat HospitalSingapore 768828Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of Surgery No.2 Kharkiv National Medical UniversityKharkiv 61022Ukraine Department of General Surgery Faculty of Medicine Zagazig UniversitySharkia 44511Egypt Department of Gastroenterology Woodlands General HospitalSingapore 737628Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

A pancreatic pseudocyst is defined as an encapsulated fluid collection with a welldefined inflammatory wall with minimal or no *** diagnosis cannot be made prior to 4 wk after the onset of *** clinical presentation is often nonspecific,with abdominal pain being the most common *** a diagnosis is suspected,contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the *** ultrasound with cyst fluid analysis can be performed in cases of diagnostic *** of the pancreas can lead to complications such as hemorrhage,infection,and *** management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications,such as biliary or gastric outlet *** options include endoscopic or surgical *** aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions,diagnosis,and management of this condition.

关键词： Pancreatic pseudocyst Pancreatic fluid collection Cystic pancreatic lesions Pancreatitis Endoscopic ultrasound

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TREXIT:initial experience with transperineal prostate biopsy under local anesthesia in an outpatient setting in South East Asia

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Asian Journal of Andrology 2021年第5期23卷 543-544页

作者： Arianto Yuwono Rolando Salada Teck Wei tan Department of Urology Tan Tock Seng Hospital11 Jalan Tan Tock SengSingapore 308433Singapore

Dear Editor,Compared to transrectal prostate biopsy,transperineal(TP)prostate biopsy avoids rectal bacteria,and thus,significantly reduces the risk of *** studies have shown extremely low rates of infection following TP prostate biopsies.1,2 Traditionally,TP prostate biopsies have been performed in the operating theater under general or spinal ***,the introduction of the PrecisionPoint Transperineal Access System(Perineologic,Cumberland,MD,USA)facilitates freehand TP prostate biopsies to be performed under local anesthesia(LA).1,2 In this study,we present our initial experience with TP prostate biopsy using the device under LA in an outpatient *** is the first report of TP prostate biopsy under LA in South East Asia.

关键词： anesthesia biopsy perineal

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On-table hepatopancreatobiliary surgical consults for difficult cholecystectomies:A 7-year audit

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 273-278页

作者： Kai Siang Chan Elizabeth Hwang JeeKeem Low SameerP Junnarkar Cheong Wei Terence Huey Vishal G Shelat Department of General Surgery Tan Tock Seng Hospital308433Singapore

Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury(BDI) and should refer to hepatopancreatobiliary(HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy. Methods: This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as “proactive” and “reactive”, where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected. Results: The median age of the patients was 62.5 years [interquartile range(IQR) 50.8–71.3 years]. Eight(16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients(median 5 mm, IQR 4–7 mm), and common bile duct was of normal caliber in all patients(median 5 mm, IQR 4–6 mm). Median length of operation and length of stay were 165 min(IQR 124–209 min) and five days(IQR 3–7 days), respectively. Subtotal cholecystectomy was performed in 18(36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15(31%) required open conversion;majority(9/15, 60%) were initiated before on-table consult. Majority of referrals(98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations(30%), presence of dense adhesions and/or contracted gallbladder(18%) and impacted stones in Hartmann’s pouch(16%). Three(6%) patients were referred for BDI(2 Strasberg D and 1 Strasberg E1), and two(4%) were referred for torrential bleeding from arterial injury(1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality. Conclusions: Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion i

关键词： Bile duct injury Cholecystectomy Cholecystitis On-table consult Quality indicators Hepatopancreatobiliary surgery

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Shockwave intravascular lithotripsy and drug-coated balloon angioplasty in calcified coronary arteries:preliminary experience in two cases

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Journal of Geriatric Cardiology 2021年第8期18卷 689-691页

作者： Hee Hwa Ho Jin Hyun Lee Deanna Zhi Lin Khoo Ko Ko Soe Hpone Ki Fung Cliff Li Department of Cardiology Tan Tock Seng Hospital

Heavily calcified coronary arteries are extremely difficult to treat as calcium deposits "hardens" the arteries and alter vascular compliance. Intravascular lithotripsy (IVL)is a new technology consisting of a balloon-based system with miniaturized lithotripsy emitters that create a localised field effect to crack calcium in the arterial wall. Drug-coated balloon (DCB) angioplasty is an alternative treatment option in percutaneous coronary intervention (PCI) with an attractive strategy of leaving nothing behind combined with local drug delivery. In this brief clinical report, we described our early experience of using a novel combination of IVL and DCB angioplasty in two elderly patients with good angiographic results.

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Can propensity score matching replace randomized controlled trials?

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World Journal of Methodology 2024年第1期14卷 58-70页

作者： Matthias Yi Quan Liau En Qi Toh Shamir Muhamed Surya Varma Selvakumar Vishalkumar Girishchandra Shelat Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Surgical Science Training Centre Tan Tock Seng HospitalSingapore 308433Singapore

Randomized controlled trials(RCTs)have long been recognized as the gold standard for establishing causal relationships in clinical *** that,various limitations of RCTs prevent its widespread implementation,ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria,amongst ***,with the introduction of propensity score matching(PSM)as a retrospective statistical tool,new frontiers in establishing causation in clinical research were opened *** predicts treatment effects using observational data from existing sources such as registries or electronic health records,to create a matched sample of participants who received or did not receive the intervention based on their propensity scores,which takes into account characteristics such as age,gender and *** its retrospective nature and its use of observational data from existing sources,PSM circumvents the aforementioned ethical issues faced by *** of RCTs exclude elderly,pregnant women and young children;thus,evidence of therapy efficacy is rarely proven by robust clinical research for this *** the other hand,by matching study patient characteristics to that of the population of interest,including the elderly,pregnant women and young children,PSM allows for generalization of results to the wider population and hence greatly increases the external *** of replacing RCTs with PSM,the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each *** example,in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial,the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization ***,PS

关键词： Propensity score matching Randomized controlled trials Randomization Clinical practice Validity Ethics

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