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Learning Laparoscopic Liver Resection for Liver Cancer
Tan To Cheung Korean Society of Gastrointestinal Cancer 2017 Journal of digestive cancer reports Vol.5 No.1
The number of laparosocpic liver resection performed every years has been increasing. There is a trend than more major hepatectomy and complex liver resection is being reported. However there has been a major obstacles in many centers because open liver resection is still considered as a gold standard and many surgeons are still getting used to the old method of liver resection. To start a new procedure, education and training is essential in order to achieve a good outcome without compromising the safety of the patients. A gradual progression is crucial in order to avoid dreadful complication. The development of the consensus meeting and difficulty score has facility the understanding of safe practice in the development of laparoscopic liver resection. In a long run, development of registry system will improve transparency and safety of this operation.
Is Adjuvant Transarterial Chemoembolization Useful for Hepatocellular Carcinoma?
( Wong Hoi She ),( Cheung Tan To ),( Simon H. Y. Tsang ),( Wing Chiu Dai ),( Albert C. Y. Chan ),( Kenneth S. H. Chok ),( Kelvin K. C. Ng ),( Chung Mau Lo ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Hepatectomy is the well-established curative treatment for hepatocellular carcinoma (HCC). However, adjuvant therapy is still controversial. This study tried to look into the effect of transarterial chemoembolization (TACE) in patients receiving hepatectomy for HCC. Methods: This is a retrospective study held in a single institution using prospectively maintained database for all the patients who underwent hepatectomy for HCC between January 2000 - December 2015. The perioperative details, pathological data and outcome were studied. Patients were matched at 1:10 ratio with comparable tumor size, number, indocyanine green retention test at 15 minutes, Child’s grading and tumor staging. The Kaplan-Meier method was used for survival analysis. The log-rank test was used for survival comparison. Results: There were total 1316 patients underwent hepatectomy for HCC. 38 patients with TACE were identified, and matched with 380 patients without TACE. The patients’ characteristics including age, sex, comorbidity, Child’s grading, ICG, tumor size and numbers were the same. The median sizes of the tumor were similar (9cm in TACE vs 8cm). There was no difference in terms of intraoperative management, extent of hepatectomy and postoperative complications. There were more patients with margin involvement in TACE group (23.7% vs 7.9%, p=0.004). The staging of the disease showed no significant difference in both groups. The disease free survival was similar (12.6 (TACE) vs 10.1months, p=0.794). There was no difference in overall survival with median survival of 27.8 (TACE) vs 36.9 months (5-year overall survival of 27.9% vs 41.2%, p=0.941). Conclusions: Margin involvement was known to be adverse factor for survival. Adjuvant TACE may benefit high-risk HCC patients with margin involvement as shown to have similar survival for those patients without margin involvement.
Rex Wan-Hin Hui,Lung-Yi Mak,Tan-To Cheung,Victor Ho-Fun Lee,Wai-Kay Seto,Man-Fung Yuen 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.2
Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.