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How to Get into a Good Fellowship?
Ser Yee Lee,Shu Ming, Chai,Chung Yip Chan Korean Society of Gastrointestinal Cancer 2017 Journal of digestive cancer reports Vol.5 No.1
A specialist in the medical field is probably one of the most time-consuming professions to train for before one is considered an expert. Inclusive of medical school, it can take as long as 20 or more years of structured training before one graduates as a new specialist in a particular surgical subspecialty or medical field. A fellowship is often the last official phase in this professional marathon, typically defined as a 1 to 2-year full-on clinical subspecialty experience. One would expect this important "finishing school" to be well researched and written about, however, as compared to other professionals and fields, there is scanty literature on how one can get into a good fellowship program. This is a perspective piece on the intricacies of securing a position in a good fellowship program, drawn from the collective experience of the authors, their colleagues and friends. There are several ways to achieve this and many processes one will encounter. A variety of factors one will need to consider, decide and works towards in this effort of optimizing of their chances of success in getting into their fellowship program of choice. The thought processes, suggestions and solutions at each phase may be helpful. In conclusion, obtaining a choice fellowship position is as much an art as a science, and maybe some luck. Many factors, some more obvious and objective, some softer and more subtle, can all influence the outcome in one way or another.
A single institution experience with robotic and laparoscopic distal pancreatectomies
Shi Qing Lee,Tousif Kabir,Ye-Xin Koh,Jin-Yao Teo,Ser-Yee Lee,Juinn-Huar Kam,Peng-Chung Cheow,Prema Raj Jeyaraj,Pierce K. H. Chow,London L. Ooi,Alexander Y. F. Chung,Chung-Yip Chan,Brian K. P. Goh 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.3
Backgrounds/Aims: This study aims to describe our experience with minimally-invasive distal pancreatectomies, with emphasis on the comparison between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Methods: Retrospective review of 102 consecutive RDP and LDP from 2006 to 2019 was performed. Results: There were 27 and 75 patients who underwent RDP and LDP, respectively. There were 12 (11.8%) open conversions and 16 (15.7%) patients had major (>grade 2) morbidities. Patients who underwent RDP had significantly higher rates of splenic preservation (44.4% vs. 13.3%, p=0.002), higher rates of splenic-vessel preservation (40.7% vs. 9.3%, p=0.001), higher median difficulty score (5 vs. 3, p=0.002) but longer operation time (385 vs. 245 minutes, p<0.001). The rate of open conversion tended to be lower with RDP (3.7% vs. 14.7%, p=0.175). Conclusions: In our institution practice, both RDP and LDP were safe and effective. The use of RDP appeared to be complementary to LDP, allowing us to perform more difficult procedures with comparable postoperative outcomes.
Hwee Leong Tan,Ek Khoon Tan,Jin Yao Teo,Juinn Huar Kam,Ser Yee Lee,Peng Chung Cheow,Prema Raj Jeyaraj,Pierce K. Chow,Alexander Y. Chung,London L. Ooi,Chung Yip Chan,Brian K. P. Goh 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.3
Backgrounds/Aims: Solid pseudopapillary neoplasm (SPPN) is typically seen in young healthy females who would likely benefit from minimally-invasive pancreatectomy (MIP). A few comparative studies have suggested that MIP is associated with favorable outcomes when compared to the open approach for SPPN. This study aims to mitigate potential selection bias by performing a matched case-control study comparing MIP vs open pancreatectomy (OP) for SPPN. Methods: We performed a single-institution retrospective electronic chart review of all patients who underwent surgery for pathologically confirmed SPPN between 2000 and 2017. A 2:1 matched comparison using age, gender, tumor size and the type of pancreatectomy was performed between OP and MIP. Results: A total of 40 patients with a median age of 40.3 years (range 16.5-64.4) and female sex predominance (n=34, 85.0%) underwent surgery during the study period. Nine patients underwent MIP. Matched comparison between 18 OP and 9 MIP demonstrated that MIP was associated with a longer median operating time (305 vs 180 min, p=0.046) and shorter median postoperative stay (6 vs 9 days, p=0.015). There were no significant differences in intraoperative blood loss, blood transfusion requirements, postoperative morbidity (including postoperative pancreatic fistula) and mortality, resection margins, lymph node yield and long-term survival. Conclusions: MIP is a safe and viable option in the management of SPPN with the benefit of a shorter postoperative length of stay at the expense of a longer operation time. There was no significant difference in oncologic outcomes between both groups of patients.
Yuxin Guo,Ek-Khoon Tan,Nicholas L. Syn,Thinesh-Lee Krishnamoorthy,Chee-Kiat Tan,Reina Lim,Ser-Yee Lee,Chung-Yip Chan,Peng-Chung Cheow,Alexander Y. F. Chung,Prema Raj Jeyaraj,Brian K. P. Goh 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.4
Backgrounds/Aims: Repeat liver resection (RLR) and salvage liver transplantation (SLT) are viable treatment options for recurrent hepatocellular carcinoma (HCC). With possibly superior survival outcomes than RLR, SLT is however, limited by liver graft availability and poses increased perioperative morbidity. In this study, we seek to compare the outcomes of RLR and SLT for patients with recurrent HCC. Methods: Between 1999 and 2018, 94 and 16 consecutive patients who underwent RLR and SLT respectively were identified. Further retrospective subgroup analysis was conducted, comparing 16 RLR with 16 SLT patients via propensity-score matching. Results: After propensity-score adjusted analyses, SLT demonstrated inferior short-term perioperative outcomes than RLR, with increased major morbidity (57.8% vs 5.4 %, p=0.0001), reoperations (39.1% vs 0, p<0.0001), renal insufficiency (30.1% vs 3%, p=0.0071), bleeding (19.8% vs 2.2%, p=0.0289), prolonged intensive care unit stay (median=4 vs 0 days, p<0.0001) and hospital stay (median= 19.8 vs 7.1days, p<0.001). However, SLT showed significantly lower recurrence rate (15.4% versus 70.3%, p=0.0005) and 5-year cumulative incidence of recurrences (19.4% versus 68.4%, p=0.005). Propensity-matched subgroup analysis showed concordant findings. Conclusions: While SLT offers potentially reduced risks of recurrence and trended towards improved long-term survival outcomes relative to RLR, it has poorer short-term perioperative outcomes. Patient selection is prudent amidst organ shortages to maximise allocated resources and optimise patient outcomes.
Outcomes of salvage liver transplant for recurrent hepatocellular carcinoma
Yuxin Guo,Ek-Khoon Tan,Thinesh-Lee Krishnamoorthy,Chee-Kiat Tan,Ban-Hock Tan,Thuan-Tong Tan,Ser-Yee Lee,Chung-Yip Chan,Peng-Chung Cheow,Alexander Y. F. Chung,Prema Raj Jeyaraj,Brian K. P. Goh 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.1
Backgrounds/Aims: Salvage liver transplantation (SLT) is a therapeutic strategy for recurrent hepatocellular carcinoma (HCC). However, it remains controversial with compromised survival outcomes and increased perioperative morbidity compared to primary liver transplant (PLT). In the present work, we describe our institution’s experience on SLT by comparing outcomes of SLT to PLT for HCCs. Methods: Retrospective analysis was conducted for 49 transplant patients from 2006-2017. A comparative analysis was carried out between 14 SLT patients and 35 PLT patients. Results: SLT patients demonstrated significantly shorter time to recurrence than PLT patients (median=5.5 versus 23 months, p<0.001) with a trend towards increased perioperative major morbidity (42.9% versus 37%, p=0.711), inferior 5-year overall survival (61% versus 75%, p=0.345) and inferior 5-year recurrence-free survival (57% versus 72%, p=0.263). However, overall survival from the point of primary resection over a 10-year period showed no statistical difference between the 2 groups (SLT=60% versus PLT=61%, p=0.685). Conclusions: SLT is a viable treatment strategy for HCCs. However, it exhibited poorer short-term perioperative and oncologic outcomes than PLT. SLT requires better patient selection with liver donor grafts for optimization of resource allocation in this era of organ shortage. Considering the worldwide shortages in liver grafts, it is hypothesized that optimization of a salvage transplant strategy may improve resource allocation and reap optimal patient outcomes.
Darren Chua,Albert Low,Yexin Koh,Brian Goh,Peng Chung Cheow,Juinn Har Kam,Jin Yao Teo,Ek Khoon Tan,Alexander Chung,London Lucien Ooi,Chung Yip Chan,Ser Yee Lee 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3
Backgrounds/Aims: Hilar cholangiocarcinomas (HCCAs) are tumors that involve the biliary confluence; at present, radical surgery offers the only chance of long-term survival, but this can be challenging given the complexity of the hilar anatomy. Blumgart and Jarnagin described a preoperative staging system that incorporates the effect of local tumor extent and its impact on adjacent structures and that has been demonstrated to correlate better with actual surgical resectability. The primary aim of this study is to describe the correlation between preoperative Blumgart-Jarnagin staging and its correlation with surgical resectability. Methods: Patients who underwent surgical resection for hilar cholangiocarcinoma at Singapore General Hospital between January 1, 2002, and January 1, 2013, were identified from a prospectively maintained institutional database. All patients were staged based on the criteria described by Blumgart and Jarnagin. Correlation with surgical resectability was then determined. Results: A total of 19 patients were identified. Overall resectability was 57.8% (n=11). Patients with Blumgart-Jarnagin stage T1 had the highest rates of respectability at 80%; patients with stage T2 and T3 disease had resectability rates of 25% and 40% respectively. Median overall survival was 13.6 months. Conclusions: The Blumgart-Jarnagin staging system is useful for predicting tumor respectability in HCCA.