|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 1 | Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016显示文摘Portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT. | Stephen L Chan Charing CN Chong Anthony WH Chan Darren MC Poon Kenneth SH Chok | 2016 | World Journal of Gastroenterology2016，22，32： | 44 |
| 2 | High-intensity focused ultrasound ablation:An effective bridging therapy for hepatocellular carcinoma patients显示文摘AIM:To analyze whether high-intensity focused ultrasound(HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma(HCC).METHODS:From January 2007 to December 2010,49 consecutive HCC patients were listed for liver transplantation(UCSF criteria).The median waiting time for transplantation was 9.5 mo.Twenty-nine patients received transarterial chemoembolization(TACE) as a bringing therapy and 16 patients received no treatment before transplantation.Five patients received HIFU ablation as a bridging therapy.Another five patients with the same tumor staging(within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison.Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores,tumor size and number,and cause of cirrhosis.RESULTS:The HIFU group and TACE group showed no difference in terms of tumor size and tumor number.One patient in the HIFU group and no patient in the TACE group had gross ascites.The median hospital stay was 1 d(range,1-21 d) in the TACE group and two days(range,1-9 d) in the HIFU group(P < 0.000).No HIFU-related complication occurred.In the HIFU group,nine patients(90%) had complete response and one patient(10%) had partial response to the treatment.In the TACE group,only one patient(3%) had response to the treatment while 14 patients(48%) had stable disease and 14 patients(48%) had progressive disease(P = 0.00).Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list(P = 0.559).CONCLUSION:HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis.It may reduce the drop-out rate of liver transplant candidate. | Tan To Cheung Sheung Tat Fan See Ching Chan Kenneth SH Chok Ferdinand SK Chu Caroline R Jenkins Regina CL Lo James YY Fung Albert CY Chan William W Sharr Simon HY Tsang Wing Chiu Dai Ronnie TP Poon Chung Mau Lo | 2013 | World Journal of Gastroenterology2013，19，20： | 23 |
| 3 | Colorectal liver metastases:An update on multidisciplinary approach显示文摘Liver metastasis is the commonest form of distant metastasis in colorectal cancer.Selection criteria for surgery and liver-directed therapies have recently been extended.However,resectability remains poorly defined.Tumour biology is increasingly recognized as an important prognostic factor;hence molecular profiling has a growing role in risk stratification and management planning.Surgical resection is the only treatment modality for curative intent.The most appropriate surgical approach is yet to be established.The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach;these two strategies have comparable long-term outcomes.For patients with a limited future liver remnant,portal vein embolization,combined ablation and resection,and associating liver partition and portal vein ligation for staged hepatectomy have been advocated,and each has their pros and cons.The role of neoadjuvant and adjuvant chemotherapy is still debated.Targeted biological agents and loco-regional therapies(thermal ablation,intra-arterial chemo-or radio-embolization,and stereotactic radiotherapy) further improve the already favourable results.The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials.Evidencebased protocols are missing,and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team. | Felix Che-Lok Chow Kenneth Siu-Ho Chok | 2019 | World Journal of Hepatology2019，11，2： | 20 |
| 4 | Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm显示文摘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. | Kin Pan Au Kenneth Siu Ho Chok | 2018 | World Journal of Gastroenterology2018，24，45： | 18 |
| 5 | Combined resection and radiofrequency ablation for multifocal hepatocellular carcinoma: Prognosis and outcomes显示文摘AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease. | Tan To Cheung Kelvin K Ng Kenneth S Chok See Ching Chan Ronnie T Poon Chung Mau Lo Sheung Tat Fan | 2010 | World Journal of Gastroenterology2010，16，24： | 14 |
| 6 | Strategies to increase the resectability of hepatocellular carcinoma显示文摘Hepatocellular carcinoma(HCC) is best treated by liver transplantation, but the applicability of transplantation is greatly limited. Tumor resection in partial hepatectomy is hence resorted to. However, in most parts of the world, only 20%-30% of HCCs are resectable. The main reason for such a low resectability is a future liver remnant too small to be sufficient for the patient. To allow more HCC patients to undergo curative hepatectomy, a variety of ways have been developed to increase the resectability of HCC, mainly ways to increase the future liver remnants in patients through hypertrophy. They include portal vein embolization, sequential transarterial chemoembolization and portal vein embolization, staged hepatectomy, two-staged hepatectomy with portal vein ligation, and Associating Liver Partition and Portal Vein Ligation in Staged Hepatectomy. Herein we review, describe and evaluate these different ways, ways that can be life-saving. | Wong Hoi She Kenneth SH Chok | 2015 | World Journal of Hepatology2015，7，18： | 9 |
| 7 | Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability显示文摘AIM:To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.METHODS:Between January 2001 and March 2012,136 patients received pancreaticoduodenectomy for adenocarcinoma at our hospital.Seventy-eight patients diagnosed with pancreatic head carcinoma were included in this study.Among them,46 patients received standard pancreaticoduodenectomy(group 1)and32 patients received pancreaticoduodenectomy with simultaneous resection of the portal vein or the superior mesenteric vein or artery(group 2)followed by reconstruction.The immediate surgical outcomes and survivals were compared between the groups.Fifty-five patients with unresectable adenocarcinoma of the pancreas without liver metastasis who received only bypassoperations(group 3)were selected for additional survival comparison.RESULTS:The median ages of patients were 67 years(range:37-82 years)in group 1,and 63 years(range:35-86 years)in group 2.All group 2 patients had resection of the portal vein or the superior mesenteric vein and three patients had resection of the superior mesenteric artery.The pancreatic fistula formation rate was21.7%(10/46)in group 1 and 15.6%(5/32)in group2(P=0.662).Two hospital deaths(4.3%)occurred in group 1 and one hospital death(3.1%)occurred in group 2(P=0.641).The one-year,three-year and five-year overall survival rates in group 1 were 71.1%,23.6%and 13.5%,respectively.The corresponding rates in group 2 were 70.6%,33.3%and 22.2%(P=0.815).The one-year survival rate in group 3 was13.8%.Pancreaticoduodenectomy with simultaneous vascular resection was safe for pancreatic head adenocarcinoma.CONCLUSION:The short-term and survival outcomes with simultaneous resection were not compromised when compared with that of standard pancreaticoduodenectomy. | Tan To Cheung Ronnie TP Poon Kenneth SH Chok Albert CY Chan Simon HY Tsang Wing Chiu Dai See Ching Chan Sheung Tat Fan Chung Mau Lo | 2014 | World Journal of Gastroenterology2014，20，46： | 8 |
| 8 | Rapid measurement of indocyanine green retention by pulse spectrophotometry: a validation study in 70 patients with Child-Pugh A cirrhosis before hepatectomy for hepatocellular carcinoma显示文摘BACKGROUND: The indocyanine green (ICG) retention test is the most popular liver function test for selecting patients for major hepatectomy. Traditionally, it is done using spectrophotometry with serial blood sampling. The newly- developed pulse spectrophotometry is a faster alternative, but its accuracy on Child-Pugh A cirrhotic patients undergoing hepatectomy for hepatocellular carcinoma has not been well documented. This study aimed to assess the accuracy of the LiMON , one of the pulse spectrophotometry systems, in measuring preoperative ICG retention in these patients and to devise an easy formula for conversion of the results so that they can be compared with classical literature records where ICG retention was measured by the traditional method. METHODS: We measured the liver function of 70 Child-Pugh A cirrhotic patients before hepatectomy for hepatocellular carcinoma from September 2008 to January 2009. ICG retention at 15 minutes measured by traditional spectrophotometry (ICGR15) was compared with ICG retention at 15 minutes measured by the LiMON (ICGR15(L)). RESULTS: The median ICGR15 was 14.7% (5.6%-32%) and the median ICGR15(L) was 10.4% (1.2%-28%). The mean difference between them was -4.3606. There was a strong correlation between ICGR15 and ICGR15(L) (correlation coefficient, 0.844; 95% confidence interval, 0.762-0.899). The following formula was devised: ICGR15=1.16×ICGR15(L)+2.73.CONCLUSIONS: The LiMON provides a fast and repeatable way to measure ICG retention at 15 minutes, but with constant underestimation of the real value. Therefore, when comparing results obtained by traditional spectrophotometry and the LiMON, adjustment of results from the latter is necessary, and this can be done with a simple mathematical calculation using the above formula. | Tan To Cheung See Ching Chan Kenneth SH Chok Albert CY Chan Wan Ching Yu Ronnie TP Poon Chung Mau Lo Sheung Tat Fan | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，3： | 8 |
| 9 | Management of recurrent hepatocellular carcinoma after liver transplant显示文摘Hepatocellular carcinoma(HCC) is the leading cause of deaths in patients with hepatitis B or C, and its incidence has increased considerably over the past decade and is still on the rise. Liver transplantation(LT) provides the best chance of cure for patients with HCC and liver cirrhosis. With the implementation of the MELD exception system for patients with HCC waitlisted for LT, the number of recipients of LT is increasing, so is the number of patients who have recurrence of HCC after LT. Treatments for intrahepatic recurrence after transplantation and after other kinds of surgery are more or less the same, but long-term cure of posttransplant recurrence is rarely seen as it is a 'systemic' disease. Nonetheless, surgicalresection has been shown to be effective in prolonging patient survival despite the technical difficulty in resecting graft livers. Besides surgical resection, different kinds of treatment are also in use, including transarterial chemoembolization, radiofrequency ablation, highintensity focused ultrasound ablation, and stereotactic body radiation therapy. Targeted therapy and modulation of immunosuppressants are also adopted to treat the deadly disease. | Kenneth SH Chok | 2015 | World Journal of Hepatology2015，7，8： | 7 |
| 10 | Survival outcomes of liver transplantation for hepatocellular carcinoma in patients with normal, high and very high preoperative alpha-fetoprotein levels显示文摘AIM To investigate the impact of alpha-fetoprotein(AFP) on long-term recurrence rate and overall survival and we also aimed to define the level of AFP leading to a higher risk of disease recurrence and affecting patient survival.METHODS Data of adult patients who received liver transplant(LT) for hepatocellular carcinoma(HCC) at our hospital from January 2000 to December 2013 were reviewed. Reviewed data included demographic characteristics, preoperative AFP level, operative details, follow-up details, and survival outcomes. Patients were mostly listed for LT based on Milan or UCSF criteria. For the purpose of this study, normal AFP level was defined as AFP value < 10 ng/m L, high AFP level was defined as AFP value ≥ 10 to < 400 ng/m L, and very highAFP level was defined as AFP ≥ 400 ng/m L. The patients were divided into these 3 groups accordingly. Survival rates were plotted as Kaplan-Meier curves and compared by log-rank analysis. Continuous variables were expressed as median(interquartile range). Categorical variables were compared by Spearman's test. Discriminative analysis was used to define the lowest value of AFP that could affect the overall survival in study population. Statistical significance was defined by a P value of < 0.05.RESULTS Totally 250 adult patients underwent LT for HCC in the study period. Eight-four of them received deceaseddonor LT and 166 had living-donor LT. The patients were divided into 3 groups: Group A, AFP < 10 ng/m L(n = 83); Group B, AFP ≥ 10 to < 400 ng/m L(n = 131); Group C, AFP ≥ 400 ng/m L(n = 36). The commonest etiology was hepatitis-B-related cirrhosis. The Model for End-stage Liver Disease scores in these groups were similar(median, 13 vs 13 vs 12; P = 0.745). The time to operation in Group A was longer(median, 94 vs 31 vs 35 d; P = 0.001). The groups were similar in hospital mortality(P = 0.626) and postoperative complication(P = 0.702). Pathology of explants showed that the 3 groups had similar numbers of tumor nodules, but the tumors in Group C were larger(A: 2.5 cm, B: 3.0 cm, C: 4.0 cm; P = 0.003). Group C had a bigger proportion of patients who were beyond Milan criteria(P = 0.010). Poor differentiation and vascular permeation were also more common in this group(P = 0.017 and P = 0.003 respectively). It also had poorer 5-year survival(A: 85.5%, B: 82.4%, C: 66%; P = 0.029). The 5-year disease-free survival was 84.3% in Group A, 80.1% in Group B, and 61.1% in Group C. Receiver operating characteristic area under the curve for AFP in predicting tumor recurrence was 0.685. The selected cut-off value was 54 ng/m L for AFP(C-index 0.685; 95%CI: 0.592-0.779; sensitivity 0.595; specificity 0.687). On discriminative analysis, AFP value of 105 ng/m L was shown to affect the overall survival of the patients.CONCLUSION HCC patients with a high preoperative AFP level had inferior survival after LT. AFP level of 54 ng/m L was associated with disease recurrence, and AFP level of 105 ng/m L was found to be the cut-off value for overall survival difference. | Wong Hoi She Albert Chi Yan Chan Tan To Cheung Chung Mau Lo Kenneth Siu Ho Chok | 2018 | World Journal of Hepatology2018，10，2： | 7 |
| 11 | Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores显示文摘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 <25; n=68). Their 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%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (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 recipient benefit are taken into full account. | Kenneth SH Chok See Ching Chan James YY Fung Tan To Cheung Albert CY Chan Sheung Tat Fan Chung Mau Lo | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，3： | 6 |
| 12 | Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases显示文摘BACKGROUND: Acute pancreatitis is a relatively rare but potentially 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 carcinoma who had undergone transarterial chemoembolization from January 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential complications 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 patients was 61 years. Most(79.6%) of the patients suffered from HBV-related hepatocellular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin eluting bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven(0.4%) patients suffered from acute pancreatitis postchemoembolization. Six patients had chemoembolization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxorubicin 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 arte-rial variations. Four patients developed acute pancreatitisrelated 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 chemoembolization could result in serious complications, especially after treatment with doxorubicin eluting bead. Continuation of current treatment with transarterial chemoembolization after acute pancreatitis is feasible providing the initial attack is completely resolved. | Wong Hoi She Albert CY Chan Tan To Cheung Kenneth SH Chok See Ching Chan Ronnie TP Poon Chung Mau Lo | 2016 | Hepatobiliary & Pancreatic Diseases International2016，15，1： | 6 |
| 13 | Importance of surgical margin in the outcomes of hepatocholangiocarcinoma显示文摘AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from1995 to 2014 were reviewed.Patients with pathologically confirmed HCC-CC were included for analysis.Demographic,biochemical,operative and pathological data were analyzed against survival outcomes. RESULTSForty-two patients were included for analysis.The median age was 53.5 years.There were 29 males.Hepatitis B virus was identified in 73.8%of the patients.Most patients had preserved liver function.The median preoperative indocyanine green retention rate at 15 min was 10.2%.The median tumor size was 6.5 cm.Major hepatectomy was required in over 70%of the patients.Hepaticojejunostomy was performed in 6 patients.No hospital death occurred.The median hospital stay was 13 d.The median follow-up period was 32 mo.The 5-year disease-free survival and overall survival were 23.6%and 35.4%respectively.Multifocality was the only independent factor associated with diseasefree survival[P<0.001,odds ratio 4,95%confidence interval(CI):1.9-8.0].In patients with multifocal tumor(n=20),resection margin of≥1 cm was associated with improved 1-year disease-free survival(40%vs 0%;log-rank,P=0.012).CONCLUSIONHCC-CC is a rare disease with poor prognosis.Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC. | Ka Wing Ma Kenneth Siu Ho Chok | 2017 | World Journal of Hepatology2017，9，13： | 5 |
| 14 | Modulation of graft vascular inflow guided by flowmetry and manometry in liver transplantation显示文摘BACKGROUND:Survival of the partial graft after living donor liver transplantation owes much to its tremendous regenerative ability.With excellent venous outflow capacity,a graft within a wide range of graft-to-standard-liver-volume ratios can cope with portal hypertension that is common in liver transplant recipients.However,when the ratio range is exceeded,modulation of graft vascular inflow becomes necessary for graft survival.The interplay between graft-to-standard-liver-volume ratio and portal pressure,in the presence of portosystemic shunt or otherwise,requires individualized modulation of graft portal and arterial inflows.Boosting of portal inflow by shunt ligation can be guided by transonic flowmetry,whereas muting of portal inflow by splenic artery ligation can be monitored by portal electronic manometry.METHOD:We describe four cases to illustrate the above.RESULTS:One patient had hepatic artery thrombosis resulting from splenic artery steal syndrome which was the sequela of small-for-size syndrome.Emergency splenic artery ligation and re-anastomosis of the hepatic artery successfully muted the portal inflow and boosted the hepatic arterial inflow.Another patient with portal vein thrombosis underwent thrombendvenectomy.Portal inflow was boosted with ligation of portosystemic shunt,which is often present in these patients with portal hypertension.The coexistence of splenic aneurysm and splenorenal shunt required ligation of both in the third patient.The fourth patient,with portal pressure and flow monitoring,avoided ligation of a coronary vein which became a main portal inflow after portal thrombendvenectomy.CONCLUSION:Management of graft inflow modulation guided selectively by transonic flowmetry or portal manometry was described. | See Ching Chan Chung Mau Lo Kenneth SH Chok William W Sharr Tan To Cheung Simon HY Tsang Albert CY Chan Sheung Tat Fan | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，6： | 5 |
| 15 | Minimally invasive donor hepatectomy, are we ready for prime time?显示文摘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. | Kin Pan Au Kenneth Siu Ho Chok | 2018 | World Journal of Gastroenterology2018，24，25： | 5 |
| 16 | Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts显示文摘AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft. | Wong Hoi She Kenneth SH Chok James YY Fung Albert CY Chan Chung Mau Lo | 2017 | World Journal of Gastroenterology2017，23，23： | 4 |
| 17 | Surgical Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis显示文摘 | Kenneth S. H. Chok Tan To Cheung See Ching Chan Ronnie T. P. Poon Sheung Tat Fan Chung Mau Lo | 2014 | World Journal of Surgery2014，，2： | 4 |
| 18 | Sarcopenia in pancreatic cancer–effects on surgical outcomes and chemotherapy显示文摘Sarcopenia is found in up to 65% of pancreatic cancer patients. The definition and diagnostic methods for sarcopenia have changed over the years, and the measurement of skeletal muscle mass with cross-sectional imaging has become the most popular way of assessment, although the parameters measured vary among different studies. It is still debatable that there is an association between sarcopenia and postoperative pancreatic fistula, but most studies showed a higher risk in patients with sarcopenic obesity. Long-term survival is worse in sarcopenic patients, as shown by meta-analysis. Sarcopenia is also associated with decreased survival and higher toxicity in patients receiving chemotherapy, and chemotherapy also tends to potentiate sarcopenia. Treatment for sarcopenia still remains an area for research, although oral supplements, nutritional modifications and exercise training have been shown to improve sarcopenia. | Miu Yee Chan Kenneth Siu Ho Chok | 2019 | World Journal of Gastrointestinal Oncology2019，11，7： | 4 |
| 19 | Entecavir Monotherapy Is Effective in Suppressing Hepatitis B Virus After Liver Transplantation显示文摘 | James Fung Cindy Cheung See–Ching Chan Man–Fung Yuen Kenneth S.H. Chok William Sharr Wing–Chiu Dai Albert C.Y. Chan Tan–To Cheung Simon Tsang Banny Lam Ching–Lung Lai Chung–Mau Lo | 2011 | Gastroenterology2011，，4： | 3 |
| 20 | Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma显示文摘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 | Julian Tsang Albert Chan Kenneth Chok Flora Tsang Chung Mau Lo | 2017 | Hepatobiliary & Pancreatic Diseases International2017，16，3： | 3 |
您所在的机构暂未开通此部分的功能，请联系管理员