Background: Posthepatectomy liver failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy liver failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy liver failure. Methods: A literature search on posthepatectomy liver failure after hepatic resection was conducted. Based on the normal course of biochemical liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy liver failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. Results: No uniform definition of posthepatectomy liver failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy liver failure as the impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy liver failure should be graded based on its impact on clinical management. Grade A posthepatectomy liver failure requires no change of the patient's clinical management. The clinical management of patients with grade B posthepatectomy liver failure deviates from the regular course but does not require invasive therapy. The need for invasive treatment defines grade C posthepatectomy liver failure. Conclusion: The current definition of posthepatectomy liver failure is simple and easily applicable in clinical routine. This definition can be used in future studies to allow objective and accurate comparisons of operative interventions in the field of hepatic surgery. © 2011 Mosby, Inc.

Nuh Rahbari    Oliver james Garden    Padbury Robert    Brooke-Smith Mark E.    Crawford Michael    René Adam    Moritz Koch    Makuuchi Masatoshi    Ronald paul DeMatteo.    Christopher Christophi    Banting Simon W.    Usatoff Valery    Masato Nagino    Guy Maddern    Hugh Thomas J.    Jean nicolas nicolas Vauthey    Greig    Rees Myrddin    Yokoyama Yukihiro    范上达     Yuji Nimura    Figueras Joan    Capussotti Lorenzo    Markus wolfgang Büchler    Jürgen Weitz   

Surgery

2011

Background: A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established. Methods: An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management. Results: The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level >3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH. Conclusion: The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications. © 2011 International Hepato-Pancreato-Biliary Association.

Nuh Rahbari    Oliver james Garden    Padbury Robert    Guy Maddern    Moritz Koch    Hugh Thomas J.    范上达     Yuji Nimura    Figueras Joan    Jean nicolas nicolas Vauthey    Rees Myrddin    René Adam    Ronald paul DeMatteo.    Greig    Usatoff Valery    Banting Simon W.    Masato Nagino    Capussotti Lorenzo    Yokoyama Yukihiro    Brooke-Smith Mark E.    Crawford Michael    Christopher Christophi    Makuuchi Masatoshi    Markus wolfgang Büchler    Jürgen Weitz   

HPB

2011

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 disease-free survival were compared. RESULTS: In the combination group, the median age was 65 years (range, 34-77 years), the median tumor number was 3 (range, 2-9), and the median tumor size was 6 cm (range, 1.2-14 cm). In the resection group, the median age was 51.5 years (range, 27-80 years, P = 0.003), the median tumor number was 3 (range, 2-9, P = 0.574), and the median tumor size was 6 cm (range, 1-14 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 Child- Pugh 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. © 2010 Baishideng.

Tan to Cheung    Ng Kelvin K.    Kenneth siu ho Chok    See ching Chan    Ronnie Poon    Chung mau Lo    范上达    

World Journal of Gastroenterology

2010

In live donor liver transplantation, anatomical anomalies of the portal vein are more frequently encountered in right lobe than left lobe grafts. Of these, a dual portal vein is one of the most common anatomical anomalies encountered. We hereby report our method of using a recipient portal vein patch after venoplasty for reconstruction in a right lobe graft with separate anterior and posterior portal vein branches. © 2010, Hepatobiliary Pancreat Dis Int. All rights reserved.

Albert chi yan Chan    Chung mau Lo    Kenneth siu ho Chok    See ching Chan    范上达    

Hepatobiliary and Pancreatic Diseases International

2010

Orthotopic liver transplantation (OLT) is the best treatment option for selected patients with hepatocellular carcinoma (HCC) with the background of cirrhosis since this treatment modality can cure both diseases at once. Over the years, the applicability of OLT for HCC has evolved. In Asia, including Hong Kong, a shortage of deceased donor liver grafts is a universal problem having to be faced in all transplant centers. Living-donor liver transplant (LDLT) has therefore been developed to counteract organ shortage and the high prevalence of HCC. The application of LDLT for HCC is a complex process involving donor voluntarism, selection criteria for the recipient and justification with respect to long-term survival in comparison to the result of deceased donor liver transplant. This article reviews the authors' experience with OLT for HCC patients in Hong Kong, with emphasis on the applicability and outcome of LDLT for HCC. Donor voluntarismhas a significant impact on the application of LDLT. "Fast-track" LDLT in the setting of recurrence following curative treatment carries a high risk of recurrence even though the tumor stage fulfills the standard criteria. Although the survival outcome may be worse following LDLT than DDLT for HCC, LDLT is still the main treatment option for patients with transplantable HCC in Hong Kong, and a reasonable survival outcome can be achieved in selected patients with extended indications. It is particularly true that LDLT provides the only hope for patients with advanced HCC under the constricting problem of organ shortage. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.

Kelvin kwok chai Ng    Chung mau Lo    See ching Chan    Kenneth siu ho Chok    Tan to Cheung    范上达    

Journal of Hepato-Biliary-Pancreatic Sciences

2010

Liver function reserve estimation is important for selecting the appropriate patients for hepatectomy or ablation of tumors. Many liver function tests have been devised, but the indocyanine green (ICG) clearance test remains the most popular for its simplicity and perhaps accuracy. Compared with the Child-Pugh classification, the ICG retention value at 15 min (ICGR-15) after intravenous injection provides more information. Though a significant difference in ICGR-15 has been observed between patients with Child-Pugh A and B liver function, the hospital mortality rates following partial hepatectomy are not significantly different between the two groups. Yet, ICGR-15 values can differentiate patients with or without hospital mortality. The cutoff values of ICGR-15 for a safe major and minor hepatectomy are 14 and 22%, respectively. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.

范上达    

Journal of Hepato-Biliary-Pancreatic Sciences

2010

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review. © Asian Pacific Association for the Study of the Liver 2008.

Sarin    Ashish Kumar    Almeida John A.    Yogesh kumar Chawla    范上达     Garg Hitendra    Silva Janaka H.    Hamid    Rajiv Jalan    Komolmit Piyawat    George Lau    Liu Qing    Madan Kaushal    Rosmawati Mohamed    Qin Ning    Rahman Salimur    Rastogi Archana    Stephen mark Riordan    Sakhuja Puja    Didier Samuel    Shah Samir    Sharma Barjesh Chander    Sharma Praveen    Takikawa Yasuhiro    Thapa Babu Ram    Wai Chun-Tao    Yuen Man-Fung   

Hepatology International

2009

Wilson disease (WD), an autosomal recessive disorder of copper transport, is the most common inherited liver disorder in Hong Kong Chinese. This was the first local study to elucidate the molecular basis and establish an effective DNA-based diagnostic protocol. The ATP7B genes of 65 patients were amplified by polymerase chain reaction (PCR) and sequenced. Haplotype analysis was performed using D13S301, D13S314, and D13S316. The p.L770L/p.R778L status in 660 subjects was determined to estimate WD prevalence. Allele age of p.R778L was determined by the smallest homozygosity region between D13S301 and D13S270. We identified 42 different mutations with 17 being novel. p.R778L (17.3%) was the most prevalent. Exons 2, 8, 12, 13, and 16 harbored 70% mutations. Thirty-two haplotypes were associated with WD chromosomes. The estimated prevalence rate was 1 in 5,400. Three out of 660 normal subjects had p.L770L/p.R778L. In the remaining 657 individuals, neither p.L770L nor p.R778L was found. We characterized a Hong Kong Chinese-specific ATP7B mutation spectrum with great genetic diversity. Exons 2, 8, 12, 13, and 16 should be screened first. The perfect linkage disequilibrium suggested that p.R778L and its private polymorphism p.L770L originated from a single ancestor. This East-Asian-specific mutation p.R778L/p.L770L is aged at least 5,500 years. © 2007 The Japan Society of Human Genetics and Springer.

Mak Chloe Miu    Ching wan Lam    Tam Sidney    Ching lung Lai    Chan Lik-Yuen    范上达     Lau Yu-Lung    Jakyiu Lai    Yuen Patrick    Hui Joannie    Fu Chun-Cheung    Kasing Wong    Mak Wing-Lai    Tze Kong    Tong Sui-Fan    Lau Abby    Nancy Leung    Aricjosun Hui    Cheung Ka-Ming    Ko Chun-Hung    Chan Yiu-Ki    Ma Oliver    Tainin Chau    Chiu Alexander    Chan Yan-Wo   

Journal of Human Genetics

2008

Hypothesis: There is no difference in the survival benefit between salvage liver transplant and nontransplant therapies for recurrent hepatocellular carcinoma (HCC). Design: Retrospective study. Setting: Tertiary referral center. Patients: Sixty patients developed transplantable intrahepatic recurrent HCC after curative resection. Twelve patients received salvage liver transplant, whereas 48 received nontransplant therapies, including a second surgical resection, radiofrequency ablation, transarterial chemoembolization, and percutaneous ethanol injection. Main Outcome Measures: The overall survival rates were compared between the 2 groups. Clinicopathologic variables were evaluated by univariate and multivariate analyses for their influence on overall survival. Results: There was no significant difference in overall survival rates between the salvage transplant and nontransplant groups. In the nontransplant group, pTNM (pathologic TNM) staging at primary resection and the time from primary resection to tumor recurrence were identified as independent prognostic factors affecting overall survival. These 2 factors carried no prognostic value in the salvage transplant group. Patients in the salvage transplant group with stage II tumors before the primary resection or intrahepatic recurrence within 12 months of the primary resection had significantly better overall survival than did the nontransplant group with corresponding poor prognostic factors. Conclusions: Patients with transplantable intrahepatic recurrence can be treated effectively by salvage transplant or nontransplant therapies. Salvage transplant may be more beneficial to patients with stage II tumors before the primary resection and those with early intrahepatic recurrence. © 2008 American Medical Association. All rights reserved.

Ng Kelvin K.    Chung mau Lo    Chi Leung Liu    Ronnie Poon    See ching Chan    范上达    

Archives of Surgery

2008

This study characterized cancer stem cells (CSCs) in hepatocellular carcinoma (HCC) cell lines, tumor specimens, and blood samples. The CD90 cells, but not the CD90 cells, from HCC cell lines displayed tumorigenic capacity. All the tumor specimens and 91.6% of blood samples from liver cancer patients bore the CD45CD90 population, which could generate tumor nodules in immunodeficient mice. The CD90CD44 cells demonstrated a more aggressive phenotype than the CD90CD44 counterpart and formed metastatic lesions in the lung of immunodeficient mice. CD44 blockade prevented the formation of local and metastatic tumor nodules by the CD90 cells. Differential gene expression profiles were identified in the CD45CD90 and CD45CD90 cells isolated from tissue and blood samples from liver cancer patients and controls. © 2008 Elsevier Inc. All rights reserved.

Yang Zhen Fan    David Ho    Ng Michael N.    Lau Chi Keung    Wanching Yu    Ngai Patricia    Chu Patrick W.K.    Lam Chi Tat    Ronnie Poon    范上达    

Cancer Cell

2008