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  1. Article ; Online: ERAS in minimally invasive hepatectomy.

    Fung, Andrew K Y / Chong, Charing C N / Lai, Paul B S

    Annals of hepato-biliary-pancreatic surgery

    2020  Volume 24, Issue 2, Page(s) 119–126

    Abstract: Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery ...

    Abstract Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.
    Language English
    Publishing date 2020-05-26
    Publishing country Korea (South)
    Document type Journal Article ; Review
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.2020.24.2.119
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  2. Article: Robotic resection for posterosuperior liver lesions: is it really superior to laparoscopic resection?

    Fung, Andrew K Y / Lee, Kit-Fai

    Hepatobiliary surgery and nutrition

    2018  Volume 8, Issue 3, Page(s) 264–266

    Language English
    Publishing date 2018-05-23
    Publishing country China (Republic : 1949- )
    Document type Editorial ; Comment
    ZDB-ID 2812398-0
    ISSN 2304-389X ; 2304-3881
    ISSN (online) 2304-389X
    ISSN 2304-3881
    DOI 10.21037/hbsn.2018.12.12
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  3. Article: Is hepatic resection justified for non-colorectal non-neuroendocrine liver metastases? A systematic review and meta-analysis.

    Ng, Kelvin K C / Cheng, Nicole M Y / Lok, Hon-Ting / Kung, Janet W C / Fung, Andrew K Y / Chan, Stephen L

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2022  Volume 21, Issue 3, Page(s) 160–172

    Abstract: Background: Hepatic resection (HR) is effective for colorectal or neuroendocrine liver metastases. However, the role of HR for non-colorectal non-neuroendocrine liver metastases (NCNNLM) is unknown. This study aims to perform a systematic review and ... ...

    Abstract Background: Hepatic resection (HR) is effective for colorectal or neuroendocrine liver metastases. However, the role of HR for non-colorectal non-neuroendocrine liver metastases (NCNNLM) is unknown. This study aims to perform a systematic review and meta-analysis on long-term clinical outcomes after HR for NCNNLM.
    Methods: electronic search was performed to identify relevant publications using PRISMA and MOOSE guidelines. Primary outcomes were 3- and 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were post-operative morbidity and 30-day mortality.
    Results: There were 40 selected studies involving 5696 patients with NCNNLM undergone HR. Pooled data analyses showed that the 3- and 5-year OS were 40% (95% CI 0.35-0.46) and 32% (95% CI 0.29-0.36), whereas the 3- and 5-year DFS were 28% (95% CI 0.21-0.36) and 24% (95% CI 0.20-0.30), respectively. The postoperative morbidity rate was 28%, while the 30-day mortality was 2%. Subgroup analysis on HR for gastric cancer liver metastasis revealed the 3-year and 5-year OS of 39% and 25%, respectively.
    Conclusions: HR for NCNNLM may achieve satisfactory survival outcome in selected patients with low morbidities and mortalities. However, more concrete evidence from prospective study is warrant in future.
    MeSH term(s) Humans ; Prospective Studies ; Hepatectomy/adverse effects ; Liver Neoplasms/surgery ; Liver Neoplasms/pathology ; Disease-Free Survival ; Colorectal Neoplasms/pathology
    Language English
    Publishing date 2022-06-17
    Publishing country Scotland
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2022.05.003
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    Zs.A 5756: Show issues Location:
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  4. Article ; Online: Minimally invasive versus open liver resection for hepatocellular carcinoma: a propensity score matching analysis of 224 patients.

    Wong, Kam Cheung / Lee, Kit Fai / Lo, Eugene Y J / Fung, Andrew K Y / Lok, Hon Ting / Cheung, Sunny Y S / Ng, Kelvin K C / Wong, John / Lai, Paul B S / Chong, Charing C N

    Langenbeck's archives of surgery

    2023  Volume 408, Issue 1, Page(s) 118

    Abstract: Purpose: To compare the peri-operative and long-term survival outcomes of minimally invasive liver resection (MILR) (robotic or laparoscopic) with open liver resection (OLR) in patients with hepatocellular carcinoma (HCC).: Methods: Data of patients ... ...

    Abstract Purpose: To compare the peri-operative and long-term survival outcomes of minimally invasive liver resection (MILR) (robotic or laparoscopic) with open liver resection (OLR) in patients with hepatocellular carcinoma (HCC).
    Methods: Data of patients who underwent liver resection for HCC were reviewed from a prospectively collected database. Outcomes of MILR were compared with those of OLR. A propensity score matching analysis with a ratio of 1:1 was performed to minimise the potential bias in clinical pathological factors.
    Results: From January 2003 to December 2017, a total of 705 patients underwent liver resection for HCC. Amongst them, 112 patients received MILR and 593 patients received OLR. After propensity score matching, there were 112 patients in each of the MILR and OLR groups. Patients were matched by age, sex, hepatitis status, presence of cirrhosis, platelet count, albumin level, bilirubin level, alkaline phosphatase (ALP) level, alanine transferase (ALT) level, creatinine level, tumour differentiation, tumour size, tumour number, presence of tumour rupture, presence of vascular invasion, extent of liver resection (minor/major) and difficulty score. The 1-, 3- and 5-year overall survival rates were 94.4%, 90.4% and 82.3% in the MILR group vs 95.4%, 80.5% and 71.8% in the open group (p = 0.240). The 1-, 3- and 5-year disease-free survival rates were 81.0%, 63.1% and 55.8% in the MILR group vs 79.1%, 58.1% and 45.7 in the open group (p = 0.449). The MILR group demonstrated significantly less blood loss (p < 0.001), less blood transfusion (p = 0.004), lower post-operative complications (p < 0.001) and shorter hospital stay (p < 0.001) when compared with the OLR group.
    Conclusions: Our data shows MILR yielded superior post-operative outcomes to OLR, with comparable survival outcomes.
    MeSH term(s) Humans ; Liver/surgery ; Carcinoma, Hepatocellular/surgery ; Propensity Score ; Minimally Invasive Surgical Procedures ; Robotic Surgical Procedures ; Laparoscopy ; Survival Rate ; Hepatectomy/methods ; Male ; Female ; Middle Aged ; Aged ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Hemorrhage/epidemiology ; Blood Transfusion ; Neoplasm Recurrence, Local/epidemiology
    Language English
    Publishing date 2023-03-14
    Publishing country Germany
    Document type Comparative Study ; Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-023-02857-w
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  5. Article ; Online: Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis.

    Ng, Kelvin K C / Cheng, Kai-Chi / Kung, Janet W C / Ho, Kit-Man / Lok, Hon-Ting / Fung, Andrew K Y / Chong, Charing C N / Cheung, Sunny Y S / Lee, Kit-Fai / Wong, John / Lai, Paul B S

    Surgical endoscopy

    2023  Volume 38, Issue 2, Page(s) 857–871

    Abstract: Background: Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical ... ...

    Abstract Background: Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC).
    Materials and methods: From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival.
    Results: The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6 days vs. 8 days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival.
    Conclusion: LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.
    MeSH term(s) Humans ; Carcinoma, Hepatocellular ; Liver Neoplasms ; Hepatectomy/adverse effects ; Propensity Score ; Retrospective Studies ; Neoplasm Recurrence, Local/surgery ; Laparoscopy/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Length of Stay ; Treatment Outcome
    Language English
    Publishing date 2023-12-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-023-10634-5
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    Zs.A 2214: Show issues Location:
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  6. Article ; Online: The Impact of Involved Resection Margin on Recurrence and Survival After Pancreaticoduodenectomy for Periampullary Carcinoma, with Emphasis on Pancreatic Head Carcinoma.

    Lee, Kit-Fai / Lok, Hon-Ting / Fung, Andrew K Y / Kung, Janet W C / Lo, Eugene Y J / Chong, Charing C N / Wong, John / Ng, Kelvin K C / Lai, Paul B S

    World journal of surgery

    2022  Volume 47, Issue 3, Page(s) 717–728

    Abstract: Background: The supposed adverse effect of involved resection margin during pancreaticoduodenectomy (PD) for periampullary carcinoma or pancreatic head carcinoma (CaP) on long-term oncological outcomes is still inconclusive.: Methods: This is a ... ...

    Abstract Background: The supposed adverse effect of involved resection margin during pancreaticoduodenectomy (PD) for periampullary carcinoma or pancreatic head carcinoma (CaP) on long-term oncological outcomes is still inconclusive.
    Methods: This is a retrospective study on periampullary carcinoma undergoing PD. Patients with R0 (margin clear) resection were compared to patients with R1 (microscopically directly involved margin) resection. Patients with gross involved margin (R2 resection) were excluded. Long-term oncological outcomes measured included incidence and site of recurrent disease, overall survival (OS) and disease-free survival (DFS). A subgroup analysis was made on patients with CaP.
    Results: Between January 2003 and December 2019, 203 PD were identified for present study. The incidence of R1 resection was common (12% in periampullary carcinoma and 20% in CaP). In periampullary carcinoma, R1 resection had greater proportion of CaP, lesser proportion of carcinoma of ampulla (CaA), more perineural invasion, more lymph node (LN) metastasis. R1 group had a shorter OS and DFS, but no difference in the incidence and site of recurrent disease. In the subgroup of CaP (91 patients), R1 group did not differ from R0 group except for more LN metastasis. There was no difference in incidence and site of recurrent disease, OS and DFS. On multivariable analysis, R1 resection was not an independent factor for OS and DFS for periampullary carcinoma or for CaP only.
    Conclusion: Involved resection margin was not uncommon. It was not associated with higher incidence of recurrent disease including local recurrence, and was not an independent prognosticator for OS and DFS.
    MeSH term(s) Humans ; Pancreaticoduodenectomy/adverse effects ; Retrospective Studies ; Pancreatic Neoplasms/pathology ; Carcinoma/surgery ; Duodenal Neoplasms/surgery ; Prognosis ; Pancreatic Neoplasms
    Language English
    Publishing date 2022-11-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-022-06816-2
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    Zs.A 1336: Show issues Location:
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  7. Article ; Online: Impact of Intermittent Pringle Maneuver on Long-Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials.

    Lee, Kit Fai / Chong, Charing C N / Cheung, Sunny Y S / Wong, John / Fung, Andrew K Y / Lok, Hon Ting / Lai, Paul B S

    World journal of surgery

    2019  Volume 43, Issue 12, Page(s) 3101–3109

    Abstract: Background: Hepatectomy remains an important curative treatment for hepatocellular carcinoma (HCC). Intermittent Pringle maneuver (IPM) is commonly applied during hepatectomy for control of bleeding. Whether the ischemia/reperfusion injury brought by ... ...

    Abstract Background: Hepatectomy remains an important curative treatment for hepatocellular carcinoma (HCC). Intermittent Pringle maneuver (IPM) is commonly applied during hepatectomy for control of bleeding. Whether the ischemia/reperfusion injury brought by IPM adversely affects the operative outcomes is controversial. This study aims to examine whether the application of IPM during hepatectomy affects the long-term outcomes.
    Methods: Two randomized controlled trials (RCT) have been carried out previously to evaluate the short-term outcomes of IPM. The present study represented a post hoc analysis on the HCC patients from the first RCT and all patients from the second RCT, and the long-term outcomes were evaluated.
    Results: There were 88 patients each in the IPM group and the no-Pringle-maneuver (NPM) group. The patient demographics, type and extent of liver resection and histopathological findings were comparable between the two groups. The 1-, 3-, 5-year overall survival in the IPM and NPM groups was 92.0%, 82.0%, 72.1% and 93.2%, 68.8%, 58.1%, respectively (P = 0.030). The 1-, 3-, 5-year disease-free survival in the IPM and NPM groups was 73.6%, 56.2%, 49.7% and 71.6%, 49.4%, 40.3%, respectively (P = 0.366). On multivariable analysis, IPM was a favorable factor for overall survival (P = 0.035). Subgroup analysis showed that a clamp time of 16-30 min (P = 0.024) and cirrhotic patients with IPM (P = 0.009) had better overall survival.
    Conclusion: IPM provided a better overall survival after hepatectomy for patients with HCC. Such survival benefit was noted in cirrhotic patients, and the beneficial duration of clamp was 16-30 min.
    Trial registration: NCT00730743 and NCT01759901 ( http://www.clinicaltrials.gov ).
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical/prevention & control ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery ; Female ; Hemostasis, Surgical/adverse effects ; Hemostasis, Surgical/methods ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Hong Kong/epidemiology ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Reperfusion Injury/etiology ; Treatment Outcome
    Language English
    Publishing date 2019-08-14
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-019-05130-8
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    Zs.A 1336: Show issues Location:
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  8. Article: Robot-assisted minimally invasive procedures for complicated biliary stone disease.

    Lee, Kit Fai / Fung, Andrew K Y / Lok, Hon Ting / Fong, Anthony K W / Chong, Charing C N / Lai, Paul B S

    Hepatobiliary surgery and nutrition

    2018  Volume 7, Issue 3, Page(s) 185–188

    Language English
    Publishing date 2018-07-03
    Publishing country China (Republic : 1949- )
    Document type Editorial
    ZDB-ID 2812398-0
    ISSN 2304-389X ; 2304-3881
    ISSN (online) 2304-389X
    ISSN 2304-3881
    DOI 10.21037/hbsn.2017.05.12
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  9. Article ; Online: Successful robotic extirpation of diaphragmatic seeding of hepatocellular carcinoma after previous rupture.

    Lee, Kit Fai / Lok, Hon Ting / Fung, Andrew K Y / Chong, Charing C N / Cheung, Yue Sun / Wong, John / Lai, Paul B S

    Journal of robotic surgery

    2018  Volume 13, Issue 3, Page(s) 525–528

    Abstract: A 51-year-old man who was a hepatitis B carrier presented with ruptured hepatocellular carcinoma (HCC). Hepatic arterial embolization was performed for control of bleeding which was followed by staged open left lateral sectionectomy for tumor removal. ... ...

    Abstract A 51-year-old man who was a hepatitis B carrier presented with ruptured hepatocellular carcinoma (HCC). Hepatic arterial embolization was performed for control of bleeding which was followed by staged open left lateral sectionectomy for tumor removal. Pathology confirmed a 3.5 cm ruptured subcapsular HCC in a cirrhotic liver with clear resection margin. However, the alpha-fetoprotein (AFP) increased from 14 to 72 µg/L after 7 months. A 1.7 × 0.8 cm nodule at left subdiaphragmatic region abutting on the spleen but no intrahepatic lesion was seen on computed tomography (CT). Dual tracer positron emission tomography suggested the nodule was a HCC seeding with no other recurrent tumor noted. Robotic exploration was offered to patient with the possibility of splenectomy. During operation, the nodule was adherent to the diaphragm with no splenic involvement. The lesion was locally excised. The diaphragmatic defect was closed with non-absorbable suture. Recovery was uneventful and the patient was discharged on postoperative day 4. Pathology confirmed HCC cells infiltrating to skeletal muscle and fibrous tissue. The resection margin was clear. Post-operatively AFP normalised. Serial abdominal CT and ultrasound revealed no evidence of recurrent disease. Patient had a disease-free survival of 47 months after excision of tumor seeding.
    MeSH term(s) Carcinoma, Hepatocellular/diagnostic imaging ; Carcinoma, Hepatocellular/surgery ; Diaphragm/drug effects ; Diaphragm/surgery ; Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/surgery ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Seeding ; Robotic Surgical Procedures/methods ; Rupture, Spontaneous ; Tomography, X-Ray Computed ; Treatment Outcome
    Language English
    Publishing date 2018-09-29
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-018-0880-8
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  10. Article ; Online: Single-center experience on actual mid-term (≥5 years) and long-term (≥10 years) survival outcome in patients with hepatocellular carcinoma after curative hepatectomy: A bimodal distribution.

    Fung, Andrew K Y / Cheng, Nicole M Y / Chong, Charing C N / Lee, Kit-Fai / Wong, John / Cheung, Sunny Y S / Lok, Hon-Ting / Lai, Paul B S / Ng, Kelvin K C

    Medicine

    2020  Volume 99, Issue 48, Page(s) e23358

    Abstract: Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival ... ...

    Abstract Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival outcome and associated prognostic factors following curative hepatectomy for HCC in a tertiary referral center.The clinical data of 325 patients who underwent curative hepatectomy for HCC were reviewed. They were stratified into 3 groups for comparison (Group 1, overall survival <5 years; Group 2, overall survival ≥5, and <10 years; Group 3, overall survival ≥10 years). Favorable independent prognostic factors for mid- and long-term survival were analyzed.A bimodal distribution of actual survival outcome was observed, with short-term (<5 years) survival of 52.7% (n = 171), mid-term survival of 18.1% (n = 59), and long-term survival of 29.2% (n = 95). Absence of microvascular invasion (OR 3.690, 95% CI: 1.562-8.695) was independent good prognostic factor for mid-term survival. Regarding long-term overall survival, young age (OR 1.050, 95% CI: 0.920-0.986), ASA grade ≤2 (OR 3.746, 95% CI: 1.325-10.587), high albumin level (OR 1.008, 95% CI: 0.920-0.986), solitary tumor (OR 3.289, 95% CI: 1.149-7.625) and absence of microvascular invasion (OR 4.926, 95% CI: 2.192-11.111) were independent good prognostic factors.Curative hepatectomy results in bimodal actual survival outcome with favorable long-term survival rate of 29.2%. Favorable independent prognostic factors (age, ASA grade, albumin level, tumor number, and microvascular invasion) are identified for overall survival.
    MeSH term(s) Adult ; Age Factors ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery ; Disease-Free Survival ; Female ; Hepatectomy/statistics & numerical data ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Postoperative Complications/epidemiology ; Prognosis ; Retrospective Studies ; Serum Albumin ; Young Adult
    Chemical Substances Serum Albumin
    Language English
    Publishing date 2020-11-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80184-7
    ISSN 1536-5964 ; 0025-7974
    ISSN (online) 1536-5964
    ISSN 0025-7974
    DOI 10.1097/MD.0000000000023358
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