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2. Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

Author

Cheung, Tan-To, Wang, Xiaoying, Efanov, Mikhail, Liu, Rong, Fuks, David, Choi, Gi-Hong, Syn, Nicholas L, Chong, Charing C, Sucandy, Iswanto, Chiow, Adrian K H, Marino, Marco V, Gastaca, Mikel, Lee, Jae Hoon, Kingham, T Peter, D'Hondt, Mathieu, Choi, Sung Hoon, Sutcliffe, Robert P, Han, Ho-Seong, Tang, Chung Ngai, Pratschke, Johann, Troisi, Roberto I, Goh, Brian K P, montalti r, Cheung, Tan-To, Wang, Xiaoying, Efanov, Mikhail, Liu, Rong, Fuks, David, Choi, Gi-Hong, Syn, Nicholas L, Chong, Charing C, Sucandy, Iswanto, Chiow, Adrian K H, Marino, Marco V, Gastaca, Mikel, Lee, Jae Hoon, Kingham, T Peter, D'Hondt, Mathieu, Choi, Sung Hoon, Sutcliffe, Robert P, Han, Ho-Seong, Tang, Chung Ngai, Pratschke, Johann, Troisi, Roberto I, Goh, Brian K P, and Montalti, R

Subjects
huge tumour, medicine.medical_specialty, Blood transfusion, Tumor size, Large tumour, business.industry, medicine.medical_treatment, Minimally invasive liver resection (MILR), hepatocellular carcinoma, laparoscopic liver resection, Perioperative, medicine.disease, Resection, Matched cohort, Blood loss, Hepatocellular carcinoma, Medicine, Original Article, robotic-assisted liver resection, Radiology, business
Abstract

Background The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented. Methods Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables. Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff. Results Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours. There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM. Conclusions MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal.

Published
2021

4. Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases

Author

Liu, Qu, Zhang, Wanguang, Zhao, Joseph J, Syn, Nicholas L, Cipriani, Federica, Alzoubi, Mohammad, Aghayan, Davit L, Siow, Tiing-Foong, Lim, Chetana, Scatton, Olivier, Herman, Paulo, Coelho, Fabricio Ferreira, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung-Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Valle, Bernardo Dalla, Ruzzenente, Andrea, Yong, Chee-Chien, Chen, Zewei, Yin, Mengqiu, Fondevila, Constantino, Efanov, Mikhail, Morise, Zenichi, Di Benedetto, Fabrizio, Brustia, Raffaele, Valle, Raffaele Dalla, Boggi, Ugo, Geller, David, Belli, Andrea, Memeo, Riccardo, Gruttadauria, Salvatore, Mejia, Alejandro, Park, James O, Rotellar, Fernando, Choi, Gi-Hong, Robles-Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Schmelzle, Moritz, Pratschke, Johann, Tang, Chung-Ngai, Chong, Charing C N, Lee, Kit-Fai, Meurs, Juul, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Kingham, T Peter, Ferrero, Alessandro, Ettorre, Giuseppe Maria, Sandri, Giovanni Battista Levi, Saleh, Mansour, Cherqui, Daniel, Zheng, Junhao, Liang, Xiao, Mazzotta, Alessandro, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Kato, Yutaro, Sugioka, Atsushi, D'Silva, Mizelle, Han, Ho-Seong, Nghia, Phan Phuoc, Long, Tran Cong Duy, Edwin, Bjørn, Fuks, David, Chen, Kuo-Hsin, Hilal, Mohammad Abu, Aldrighetti, Luca, Liu, Rong, and Goh, Brian K P

Published
2023

5. Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies

Author

Coelho, Fabricio Ferreira, Herman, Paulo, Kruger, Jaime A P, Andrew G R, Wu, Chin, Ken-Min, Hasegawa, Kiyoshi, Zhang, Wanguang, Alzoubi, Mohammed, Aghayan, Davit L, Siow, Tiing-Foong, Scatton, Olivier, Kingham, T Peter, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Dokmak, Safi, Fondevila, Constantino, Efanov, Mikhail, Morise, Zenichi, Di Benedetto, Fabrizio, Brustia, Raffaele, Valle, Raffaele Dalla, Boggi, Ugo, Geller, David, Belli, Andrea, Memeo, Riccardo, Gruttadauria, Salvatore, Mejia, Alejandro, Park, James O, Rotellar, Fernando, Choi, Gi Hong, Robles-Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric C H, Chong, Charing C N, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Liu, Rong, Ferrero, Alessandro, Ettorre, Giuseppe Maria, Cipriani, Federica, Cherqui, Daniel, Liang, Xiao, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Yin, Mengqiu, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Long, Tran Cong Duy, Fuks, David, Abu Hilal, Mohammad, Chen, Kuo-Hsin, Aldrighetti, Luca, Edwin, Bjørn, and Goh, Brian K P

Published
2023

6. Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies

Author

Berardi, Giammauro, Kingham, T Peter, Zhang, Wanguang, Syn, Nicholas L, Koh, Ye-Xin, Jaber, Bashar, Aghayan, Davit L, Siow, Tiing Foong, Lim, Chetana, Scatton, Olivier, Herman, Paulo, Coelho, Fabricio Ferreira, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Dalla Valle, Bernardo, Ruzzenente, Andrea, Yong, Chee-Chien, Chen, Zewei, Yin, Mengqiu, Fondevila, Constantino, Efanov, Mikhail, Morise, Zenichi, Di Benedetto, Fabrizio, Brustia, Raffaele, Dalla Valle, Raffaele, Boggi, Ugo, Geller, David, Belli, Andrea, Memeo, Riccardo, Gruttadauria, Salvatore, Mejia, Alejandro, Park, James O, Rotellar, Fernando, Choi, Gi-Hong, Robles-Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Schmelzle, Moritz, Pratschke, Johann, Lai, Eric C H, Chong, Charing C N, Meurs, Juul, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Liu, Qu, Liu, Rong, Ferrero, Alessandro, Ettorre, Giuseppe Maria, Cipriani, Federica, Pascual, Franco, Cherqui, Daniel, Zheng, Junhao, Liang, Xiao, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Kato, Yutaro, Sugioka, Atsushi, D'Silva, Mizelle, Han, Ho-Seong, Nghia, Phan Phuoc, Long, Tran Cong Duy, Edwin, Bjørn, Fuks, David, Abu Hilal, Mohammad, Aldrighetti, Luca, Chen, Kuo-Hsin, and Goh, Brian K P

Published
2023

7. Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

Author

Chong, Charing C, Fuks, David, Lee, Kit-Fai, Zhao, Joseph J, Choi, Gi Hong, Sucandy, Iswanto, Chiow, Adrian K H, Marino, Marco V, Gastaca, Mikel, Wang, Xiaoying, Lee, Jae Hoon, Efanov, Mikhail, Kingham, T Peter, D'Hondt, Mathieu, Troisi, Roberto I, Choi, Sung-Hoon, Sutcliffe, Robert P, Chan, Chung-Yip, Lai, Eric C H, Park, James O, Di Benedetto, Fabrizio, Rotellar, Fernando, Sugioka, Atsushi, Coelho, Fabricio Ferreira, Ferrero, Alessandro, Long, Tran Cong Duy, Lim, Chetana, Scatton, Olivier, Liu, Qu, Schmelzle, Moritz, Pratschke, Johann, Cheung, Tan-To, Liu, Rong, Han, Ho-Seong, Tang, Chung Ngai, Goh, Brian K P, montalti r., Chong, Charing C, Fuks, David, Lee, Kit-Fai, Zhao, Joseph J, Choi, Gi Hong, Sucandy, Iswanto, Chiow, Adrian K H, Marino, Marco V, Gastaca, Mikel, Wang, Xiaoying, Lee, Jae Hoon, Efanov, Mikhail, Kingham, T Peter, D'Hondt, Mathieu, Troisi, Roberto I, Choi, Sung-Hoon, Sutcliffe, Robert P, Chan, Chung-Yip, Lai, Eric C H, Park, James O, Di Benedetto, Fabrizio, Rotellar, Fernando, Sugioka, Atsushi, Coelho, Fabricio Ferreira, Ferrero, Alessandro, Long, Tran Cong Duy, Lim, Chetana, Scatton, Olivier, Liu, Qu, Schmelzle, Moritz, Pratschke, Johann, Cheung, Tan-To, Liu, Rong, Han, Ho-Seong, Tang, Chung Ngai, Goh, Brian K P, and Montalti, R.

Subjects
Liver Neoplasms, Operative Time, Robotics, Length of Stay, Middle Aged, Postoperative Complications, Treatment Outcome, Robotic Surgical Procedures, Case-Control Studies, Aged, Hepatectomy, Humans, Propensity Score, Retrospective Studies, Laparoscopy, Surgery, Original Investigation
Abstract

Importance: Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). Objective: To compare the outcomes of robotic vs laparoscopic RH/ERH. Design, setting, and participants: In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. Interventions: Robotic vs laparoscopic RH/ERH. Main outcomes and measures: Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. Results: Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46). Conclusion and relevance: Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.

Published
2022

9. Robotic and laparoscopic right anterior sectionectomy and central hepatectomy: multicentre propensity score-matched analysis

Author

Yang, Hye Yeon, Choi, Gi Hong, Chin, Ken-Min, Choi, Sung Hoon, Syn, Nicholas L., Cheung, Tan-To, Chiow, Adrian K. H., Sucandy, Iswanto, Marino, Marco V., Prieto, Mikel, Chong, Charing C., Lee, Jae Hoon, Efanov, Mikhail, Kingham, T. Peter, Sutcliffe, Robert P., Troisi, Roberto I., Pratschke, Johann, Wang, Xiaoying, D’Hondt, Mathieu, Tang, Chung Ngai, Liu, Rong, Park, James O., Rotellar, Fernando, Scatton, Olivier, Sugioka, Atsushi, Long, Tran Cong Duy, Chan, Chung-Yip, Fuks, David, Han, Ho-Seong, and Goh, Brian K. P.

Subjects
Robotic Surgical Procedures, Liver Neoplasms, Operative Time, Hepatectomy, Humans, Surgery, Laparoscopy, Propensity Score, Article, Retrospective Studies
Abstract

Both robotic and laparoscopic right anterior sectionectomy and central hepatectomy can be performed safely in expert centres, with excellent outcomes. The robotic approach was associated with statistically significant less blood loss compared with laparoscopy, although the clinical relevance of this finding remains unclear.

Published
2022

17. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade

Author

Toyoda, Hidenori, primary, Lai, Paul BS, additional, O'Beirne, James, additional, Chong, Charing C, additional, Berhane, Sarah, additional, Reeves, Helen, additional, Manas, Derek, additional, Fox, Richard P, additional, Yeo, Winnie, additional, Mo, Frankie, additional, Chan, Anthony WH, additional, Tada, Toshifumi, additional, Iñarrairaegui, Mercedes, additional, Vogel, Arndt, additional, Schweitzer, Nora, additional, Chan, Stephen L, additional, Sangro, Bruno, additional, Kumada, Takashi, additional, and Johnson, Philip J, additional

Published
2016
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19. Alternative splicing of estrogen receptor alpha in hepatocellular carcinoma.

Author

Jian Zhang, Jianwei Ren, Jiamin Wei, Chong, Charing C. N., Dongjie Yang, Yulong He, Chen, George G., and Lai, Paul B. S.

Subjects
ESTROGEN receptors, LIVER cancer, CELLULAR signal transduction, DOWNREGULATION, CANCER genetics
Abstract

Background: The role of estrogen receptor alpha (ERa), estrogen receptor beta (ERb) and ERa36 signaling in hepatocellular carcinoma (HCC) is not fully addressed. Methods: In this study, three cohorts were included: (i) primary HCC patients (N = 76, cohort P), (ii) colorectal liver metastasis (mCRC) (N = 32, cohort S), and (iii) HCC from The Cancer Genome Atlas (TCGA) (N = 121). The levels of ERa36 and wtER36 were measured and their correlation with clinicopathologic features was determined. Results: WtERa was downregulated and that ERa36 was upregulated in tumor tissues in both cohort P and TCGA data set. ERa36 was downregulated in tumor tissues in cohort S. In cohort P, wtERa was differentially expressed in gender (P < 0.000), age (P = 0.004), tumor number (P = 0.043), tumor size (P = 0.002), intrahepatic recurrence (P = 0.054). ERa36 was unequally expressed in different non-tumor liver status (P = 0.040). WtERa was negatively associated with overall survival (OS) and disease free survival (DFS) in cohort P. Compared with non-tumor tissues, the expression of ERa36 was increased in primary HCC but decreased in secondary HCC, showing opposite expression patterns of ERa36 between primary HCC and secondary HCC. Conclusions: Primary HCC is associated with the decreased WtERa but increased ERa36. The expression pattern of ERa36 is different between primary HCC and secondary HCC, as the former with the increased ERa36 but the latter with the decreased ERa36. Therefore, the expression of ERa36 may be used to differentiate the primary HCC and the secondary one. [ABSTRACT FROM AUTHOR]

Published
2016
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20. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Goh, Brian K P, Han, Ho-Seong, Chen, Kuo-Hsin, Chua, Darren W, Chan, Chung-Yip, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund A, Sijberden, Jasper, D'Silva, Mizelle, Siow, Tiing Foong, Kato, Yutaro, Lim, Chetana, Nghia, Phan Phuoc, Herman, Paulo, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqui, Chen, Zewei, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo R, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Coelho, Fabricio F, Kingham, Thomas Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Sandri, Giovanni B Levi, Saleh, Mansour, Cherqui, Daniel, Scatton, Olivier, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Hilal, Mohammad Abu, Fuks, David, Edwin, Bjørn, and Aldrighetti, Luca

Subjects
benchmark, hepatectomy, quality assessment, Settore MED/18 - CHIRURGIA GENERALE, minimally invasive, Surgery, laparoscopic liver resection, global
Abstract

To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).There is limited published data to date on the best achievable outcomes after L-LR.This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

Published
2022

21. Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

Author

Hao Ping Wang, Chee Chien Yong, Andrew G.R. Wu, Daniel Cherqui, Roberto I. Troisi, Federica Cipriani, Davit Aghayan, Marco V. Marino, Andrea Belli, Adrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Marco Vivarelli, Fabrizio Di Benedetto, Sung-Hoon Choi, Jae Hoon Lee, James O. Park, Mikel Gastaca, Constantino Fondevila, Mikhail Efanov, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung Ngai Tang, Charing C. Chong, Mathieu D’Hondt, Andrea Ruzzenente, Paolo Herman, T. Peter Kingham, Olivier Scatton, Rong Liu, Alessandro Ferrero, Giovanni Battista Levi Sandri, Olivier Soubrane, Alejandro Mejia, Santiago Lopez-Ben, Jasper Sijberden, Kazuteru Monden, Go Wakabayashi, Atsushi Sugioka, Tan-To Cheung, Tran Cong Duy Long, Bjorn Edwin, Ho-Seong Han, David Fuks, Luca Aldrighetti, Mohamed Abu Hilal, Brian K.P. Goh, Chung-Yip Chan, Nicholas Syn, Mikel Prieto, Henri Schotte, Celine De Meyere, Felix Krenzien, Moritz Schmelzle, Kit-Fai Lee, Diana Salimgereeva, Ruslan Alikhanov, Lip Seng Lee, Jae Young Jang, Kevin P. Labadie, Masayuki Kojima, Yutaro Kato, Asmund Avdem Fretland, Jacob Ghotbi, Fabricio Ferreira Coelho, Jaime Arthur Pirola Kruger, Victor Lopez-Lopez, Paolo Magistri, Bernardo Dalla Valle, Margarida Casellas I Robert, Kohei Mishima, Giuseppe Maria Ettorre, Federico Mocchegiani, Prashant Kadam, Franco Pascual, Mansour Saleh, Alessandro Mazzotta, Roberto Montalti, Mariano Giglio, Boram Lee, Mizelle D’Silva, Phan Phuoc Nghia, Chetana Lim, Qu Liu, Eric C. Lai, Wang, Hao Ping, Yong, Chee Chien, Wu, Andrew G R, Cherqui, Daniel, Troisi, Roberto I, Cipriani, Federica, Aghayan, Davit, Marino, Marco V, Belli, Andrea, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Vivarelli, Marco, Di Benedetto, Fabrizio, Choi, Sung-Hoon, Lee, Jae Hoon, Park, James O, Gastaca, Mikel, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo Roble, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Tang, Chung Ngai, Chong, Charing C, D'Hondt, Mathieu, Ruzzenente, Andrea, Herman, Paolo, Kingham, T Peter, Scatton, Olivier, Liu, Rong, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Soubrane, Olivier, Mejia, Alejandro, Lopez-Ben, Santiago, Sijberden, Jasper, Monden, Kazuteru, Wakabayashi, Go, Sugioka, Atsushi, Cheung, Tan-To, Long, Tran Cong Duy, Edwin, Bjorn, Han, Ho-Seong, Fuks, David, Aldrighetti, Luca, Abu Hilal, Mohamed, Goh, Brian K P, Wang, H. P., Yong, C. C., Wu, A. G. R., Cherqui, D., Troisi, R. I., Cipriani, F., Aghayan, D., Marino, M. V., Belli, A., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Vivarelli, M., Di Benedetto, F., Choi, S. -H., Lee, J. H., Park, J. O., Gastaca, M., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Tang, C. N., Chong, C. C., D'Hondt, M., Ruzzenente, A., Herman, P., Kingham, T. P., Scatton, O., Liu, R., Ferrero, A., Levi Sandri, G. B., Soubrane, O., Mejia, A., Lopez-Ben, S., Sijberden, J., Monden, K., Wakabayashi, G., Sugioka, A., Cheung, T. -T., Long, T. C. D., Edwin, B., Han, H. -S., Fuks, D., Aldrighetti, L., Abu Hilal, M., Goh, B. K. P., Chan, C. -Y., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Jang, J. Y., Labadie, K. P., Kojima, M., Kato, Y., Fretland, A. A., Ghotbi, J., Coelho, F. F., Pirola Kruger, J. A., Lopez-Lopez, V., Magistri, P., Valle, B. D., Casellas I Robert, M., Mishima, K., Ettorre, G. M., Mocchegiani, F., Kadam, P., Pascual, F., Saleh, M., Mazzotta, A., Montalti, R., Giglio, M., Lee, B., D'Silva, M., Nghia, P. P., Lim, C., Liu, Q., Lai, E. C., Graduate School, Surgery, and CCA - Cancer Treatment and Quality of Life

Subjects
Male, Operative Time, Length of Stay, Conversion to Open Surgery, Hepatectomy, Humans, Minimally Invasive Surgical Procedures, Postoperative Complications, Retrospective Studies, Treatment Outcome, Hypertension, Portal, Laparoscopy, Neoplasms, Hypertension, Surgery, Portal
Abstract

Background: Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes. Methods: This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases. Results: The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach. Conclusion: Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.

Published
2022

22. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P

Subjects
Carcinoma, Hepatocellular, Laparoscopic liver, Settore MED/18 - CHIRURGIA GENERALE, Operative Time, Liver Neoplasms, Carcinoma, Hepatocellular, Difficulty score, Length of Stay, Iwate, Laparoscopic hepatectomy, Right posterior sectionectomy, Treatment Outcome, Postoperative Complications, Humans, Hepatectomy, Surgery, Laparoscopy, Retrospective Studies
Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

23. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., A. G. R., Wu, Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, F., Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, F., Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Efanov, Mikhail, Salimgereeva, Diana, Alikhanov, Ruslan, Wu, Andrew G R, Geller, David, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund Avdem, Sijberden, Jasper, Belli, Andrea, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Fondevila, Constantino, Rotellar, Fernando, Choi, Gi-Hong, Robless Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Herman, Paulo, Di Benedetto, Fabrizio, Kingham, T Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Scatton, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Abu Hilal, Mohammad, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Edwin, Bjorn, and Goh, Brian K P

Subjects
hepatectomy, laparoscopy, liver resection, posterosuperior segments, risk score, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery, posterosuperior segment
Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2022

24. Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases.

Author

Cheung TT, Liu R, Cipriani F, Wang X, Efanov M, Fuks D, Choi GH, Syn NL, Chong CCN, Di Benedetto F, Robles-Campos R, Mazzaferro V, Rotellar F, Lopez-Ben S, Park JO, Mejia A, Sucandy I, Chiow AKH, Marino MV, Gastaca M, Lee JH, Kingham TP, D'Hondt M, Choi SH, Sutcliffe RP, Han HS, Tang CN, Pratschke J, Troisi RI, Wakabayashi G, Cherqui D, Giuliante F, Aghayan DL, Edwin B, Scatton O, Sugioka A, Long TCD, Fondevila C, Abu Hilal M, Ruzzenente A, Ferrero A, Herman P, Chen KH, Aldrighetti L, and Goh BKP

Abstract

Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours ≥10 cm., Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (≥10 cm) tumors at 42 international centers between 2002-2020., Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs. 21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs. 6 days, P=0.435)., Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-22-283/coif). FR reports speaker fees and support outside the submitted work from Integra, Medtronic, Olympus, Corza, Sirtex and Johnson & Johnson. MVM is a consultant for CAVA robotics LLC. JP reports a research grant from Intuitive Surgical Deutschland GmbH and personal fees or nonfinancial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, and Promedicis and serves as the unpaid editorial board member of Hepatobiliary Surgery and Nutrition. BKPG has received travel grants and honorarium from Johnson and Johnson, Olympus and Transmedic the local distributor for the Da Vinci Robot. HSH, MAH and LA serve as the unpaid editorial board members of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare., (2023 Hepatobiliary Surgery and Nutrition. All rights reserved.)

Published
2023
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25. YY1 Regulates Glucose Homeostasis Through Controlling Insulin Transcription in Pancreatic β-Cells.

Author

Liu D, Yang KY, Chan VW, Ye W, Chong CCN, Wang CC, Wang H, Zhou B, Cheng KKY, and Lui KO

Subjects
Animals, Glucose metabolism, Homeostasis, Insulin metabolism, Insulin, Regular, Human, Mice, YY1 Transcription Factor genetics, YY1 Transcription Factor metabolism, Diabetes Mellitus metabolism, Insulin-Secreting Cells metabolism
Abstract

To date, identification of nonislet-specific transcriptional factors in the regulation of insulin gene expression has been little studied. Here, we report that the expression level of the transcription factor YY1 is increased dramatically in both human and mouse pancreatic β-cells after birth. Nevertheless, the physiological role of YY1 during β-cell development and its regulatory mechanism in β-cell function remain largely unknown. After β-cell ablation of Yy1, we observed rapid onset of hyperglycemia, impaired glucose tolerance, and reduced β-cell mass in neonatal and adult mice. These mice also had hypoinsulinemia with normal insulin sensitivity compared with their wild-type littermates, manifesting as a type 1 diabetic phenotype. Mechanistically, genome-wide RNA sequencing has defined dysregulated insulin signaling and defective glucose responsiveness in β-cells devoid of YY1. Integrative analyses coupled with chromatin immunoprecipitation assays targeting YY1, and histone modifications, including H3K4me1, H3K27ac, and H3K27me3, have further identified Ins1 and Ins2 as direct gene targets of YY1. Luciferase reporter assays and loss- and gain-of-function experiments also demonstrated that YY1 binds to the enhancer regions in exon 2 of Ins1 and Ins2, activating insulin transcription and, therefore, proinsulin and insulin production in pancreatic β-cells. YY1 also directly interacts with RNA polymerase II, potentially stabilizing the enhancer-promoter interaction in the multiprotein-DNA complex during transcription initiation. Taken together, our findings suggest a role for YY1 as a transcriptional activator of insulin gene expression, assisting β-cell maturation and function after birth. These analyses may advance our understanding of β-cell biology and provide clinically relevant insights targeting the pathophysiological origins of diabetes., (© 2022 by the American Diabetes Association.)

Published
2022
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26. Novel use of the falciform ligament for reconstruction of the inferior vena cava and its tributary.

Author

Kung JWC, Chong CCN, Lee KF, Wong J, Lai PBS, and Ng KKC

Abstract

Tumor invasion into the inferior vena cava (IVC) and hepatic vein (HV) is challenging in cancer surgery with curative intent. Appropriate techniques for venous reconstruction are essential. We have described in detail a novel technique of fashioning an interposition tube graft using the falciform ligament to reconstruct the IVC and HV. The falciform ligament maintains all the benefits of an autologous tissue graft, with the added advantage of its flexibility in customizing graft dimensions. Its use in IVC and HV reconstruction has rarely been reported. The short-term outcomes with this tube graft are promising., (© 2021 The Authors.)

Published
2021
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27. Comparison of long-term survival outcome after curative hepatectomy between selected patients with non-colorectal and colorectal liver metastasis: A propensity score matching analysis.

Author

Lok HT, Fung AKY, Chong CCN, Lee KF, Wong J, Cheung SYS, Lai PBS, and Ng KKC

Subjects
Hepatectomy, Humans, Prognosis, Propensity Score, Retrospective Studies, Survival Rate, Treatment Outcome, Colorectal Neoplasms surgery, Liver Neoplasms surgery
Abstract

Background: Liver resection is an established treatment of choice for colorectal liver metastasis (CLM). However, the role of hepatectomy for non-colorectal liver metastasis (NCLM) is less clear., Patients and Method: From 2004 to 2017, 264 patients received curative hepatectomy for NCLM (n = 28) and CLM (n = 236). Propensity score (PS) matching was performed between two groups, with respect to the significant confounding factors. Short-term and long-term outcomes were compared between PS matched groups. Univariate analysis was performed to identify prognostic factors affecting overall and recurrence-free survival., Results: After PS matching, there were 28 patients in NCLM group and 56 patients in CLM group. With a median follow-up of 34 months, there was no significant difference in 5-year overall survival rate between NCLM and CLM groups (62% vs. 39%) (P = 0.370). The 5-year recurrence-free survival rate was also comparable between NCLM and CLM groups (23% vs. 22%) (P = 0.707). Use of pre-operative systemic therapy (hazard ratio: 2.335, CI 1.157-4.712), multifocal tumors (hazard ratio: 1.777, CI 1.010-3.127), tumor size (hazard ratio: 1.135, CI 1.012-1.273), R1 resection (hazard ratio: 2.484, CI 1.194-5.169) and severe complications (hazard ratio: 6.507, CI 1.454-29.124), but not tumor type (NCLM vs. CLM), were associated with poor overall survival., Conclusion: Hepatectomy for NCLM can achieve similar oncological outcomes in selected patients as those with CLM. Significant prognostic factors were identified associating with worse overall survival., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020. Published by Elsevier Taiwan LLC.)

Published
2021
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28. Single-Cell RNA-Seq Reveals that CD9 Is a Negative Marker of Glucose-Responsive Pancreatic β-like Cells Derived from Human Pluripotent Stem Cells.

Author

Li X, Yang KY, Chan VW, Leung KT, Zhang XB, Wong AS, Chong CCN, Wang CC, Ku M, and Lui KO

Subjects
Biomarkers metabolism, C-Peptide genetics, C-Peptide metabolism, Cell Differentiation, Cell Line, Cells, Cultured, Genome-Wide Association Study, Glucose metabolism, Homeodomain Proteins genetics, Homeodomain Proteins metabolism, Human Embryonic Stem Cells cytology, Humans, Islets of Langerhans cytology, Islets of Langerhans metabolism, Maf Transcription Factors, Large genetics, Maf Transcription Factors, Large metabolism, Organoids metabolism, RNA-Seq, Single-Cell Analysis, Tetraspanin 29 genetics, Transcriptome, Human Embryonic Stem Cells metabolism, Insulin-Secreting Cells metabolism, Pluripotent Stem Cells metabolism, Tetraspanin 29 metabolism
Abstract

To date, it remains unclear if there are specific cell-surface markers for purifying glucose-responsive pancreatic β-like cells derived from human pluripotent stem cells (hPSCs). In searching for this, we generated an efficient protocol for differentiating β-like cells from human embryonic stem cells. We performed single-cell RNA sequencing and found that CD9 is a negative cell-surface marker of β-like cells, as most INS + cells are CD9 - . We purified β-like cells for spontaneous formation of islet-like organoids against CD9, and found significantly more NKX6.1 + MAFA + C-PEPTIDE + β-like cells in the CD9 - than in the CD9 + population. CD9 - cells also demonstrate better glucose responsiveness than CD9 + cells. In humans, we observe more CD9 + C-PEPTIDE + β cells in the fetal than in the adult cadaveric islets and more Ki67 + proliferating cells among CD9 + fetal β cells. Taken together, our experiments show that CD9 is a cell-surface marker for negative enrichment of glucose-responsive β-like cells differentiated from hPSCs., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2020
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29. Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial).

Author

Chong CCN, Lee KF, Cheung SYS, Chu CCM, Fong AKW, Wong J, Hui JWY, Fung AKY, Lok HT, Lo EYJ, Chan SL, Yu SCH, Ng KKC, and Lai PBS

Subjects
Humans, Microwaves adverse effects, Prospective Studies, Treatment Outcome, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular surgery, Catheter Ablation adverse effects, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Radiofrequency Ablation adverse effects
Abstract

Background: Microwave (MWA) and radiofrequency ablation are the commonly used local ablation for hepatocellular carcinoma (HCC). Studies comparing both techniques are scarce. The aim of this study was to compare the efficacy of MWA versus RFA as a treatment for HCC., Methods: Patients with HCC who were suitable for local ablation were randomized into MWA or RFA. All patients were followed up regularly with contrast-enhanced computed tomography (CT) performed at 1, 3, 6 and 12 months after ablation. Both patients and the radiologists who interpreted the post-procedure CT scans were blinded to the treatment allocation. Treatment-related morbidity, overall and disease-free survivals were analyzed., Results: A total of 93 patients were recruited. Among them, 47 and 46 patients were randomized to MWA and RFA respectively. Patients in two groups were comparable in baseline demographics and tumor characteristics. With a median follow-up of around 30 months, there were no significant difference in the treatment-related morbidity, overall and disease-free survivals. MWA had a significantly shorter overall ablation time when compared with RFA (12 min vs 24 min, p < 0.001)., Conclusions: MWA is no different to RFA with respect to completeness of ablation and survivals. It is, however, as safe and effective as RFA in treating small HCC., (Copyright © 2020. Published by Elsevier Ltd.)

Published
2020
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30. Microwave ablation provides better survival than liver resection for hepatocellular carcinoma in patients with borderline liver function: application of ALBI score to patient selection.

Author

Chong CCN, Lee KF, Chu CM, Chan AWH, Wong J, Chan SL, Lok HT, Fung AKY, Fong AKW, Cheung YS, Yu SCH, Johnson P, and Lai PBS

Subjects
Aged, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Clinical Decision-Making, Databases, Factual, Disease-Free Survival, Female, Humans, Liver Neoplasms blood, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Microwaves adverse effects, Middle Aged, Patient Selection, Predictive Value of Tests, Retrospective Studies, Risk Factors, Time Factors, Ablation Techniques adverse effects, Ablation Techniques mortality, Bilirubin blood, Carcinoma, Hepatocellular surgery, Hepatectomy adverse effects, Hepatectomy mortality, Liver Function Tests, Liver Neoplasms surgery, Microwaves therapeutic use, Serum Albumin, Human analysis
Abstract

Background: Studies comparing microwave ablation (MWA) and liver resection are lacking. This study evaluates the survival of patients with hepatocellular carcinoma (HCC) treated with liver resection or MWA and the role of Albumin-Bilirubin (ALBI) score in patient selection for treatments., Methods: This is a retrospective analysis of patients who received curative liver resection or MWA for HCC. Propensity score matching was used at a 1:1 ratio. The value of ALBI grade for patient selection was evaluated. Overall and disease-free survival were compared between two groups., Results: Of the 442 patients underwent MWA or liver resection for HCC during the study period, 63 patients received MWA and 379 patients received liver resection. Propensity scoring matching analysis resulted in 63 matched pairs for further analysis. Subgroup analysis according to the ALBI grade was performed. Liver resection offered better overall and disease-free survivals in patients with ALBI grade 1. MWA provided a significantly better overall survival (p = 0.025) and a trend towards better disease-free survival (p = 0.39) in patients with ALBI grade 2 or 3., Conclusions: Liver resection offered superior disease-free survival to MWA in patients with HCC. The ALBI grade could identify patients with worse liver function who might gain survival advantage from MWA., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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31. Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma.

Author

Cheung TT, Kwok PC, Chan S, Cheung CC, Lee AS, Lee V, Cheng HC, Chia NH, Chong CCN, Lai TW, Law ALY, Luk MY, Tong CC, and Yau TCC

Abstract

Background: Hepatocellular carcinoma (HCC) is highly prevalent in Hong Kong due to the high prevalence of chronic hepatitis B infection. Liver cancer is the fourth most common cancer and the third most common cause of cancer death. Due to the high case load, there is a high level of local expertise in treating HCC, and the full spectrum of treatment modalities is available. This document summarizes how these modalities should be used based on the latest evidence., Summary: In 2 meetings held in early 2017, a multidisciplinary group of Hong Kong clinicians, including liver surgeons, interventional radiologists, clinical oncologists, and medical oncologists, met to update local consensus statements for management of HCC. These statements are based on the latest evidence and give detailed guidance on how to deploy these modalities, in particular for cases of HCC which are not suited to surgical resection., Key Messages: These statements give detailed information on how to decide if a patient is a candidate for resection, methods to improve candidacy for resection, and guidance for use of various nonsurgical interventions to manage patients ineligible for resection.

Published
2018
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32. Can echogenic appearance of neuroendocrine liver metastases on intraoperative ultrasonography predict tumor biology and prognosis?

Author

Dogeas E, Chong CCN, Weiss MJ, Ahuja N, and Choti MA

Subjects
Aged, Cell Differentiation, Disease-Free Survival, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Metastasectomy, Middle Aged, Neoplasm Grading, Neuroendocrine Tumors mortality, Neuroendocrine Tumors pathology, Neuroendocrine Tumors surgery, Predictive Value of Tests, Prospective Studies, Risk Factors, Time Factors, Tumor Burden, Intraoperative Care methods, Liver Neoplasms diagnostic imaging, Neuroendocrine Tumors diagnostic imaging, Ultrasonography
Abstract

Background: Determining the biologic behavior of neuroendocrine liver metastases (NELM) is important when managing patients with this disease. We sought to define the intraoperative ultrasound (IOUS) characteristics of NELM and correlate with tumor biology and prognosis., Methods: Prospective data on patients who underwent IOUS and surgical intervention for NELM were collected, with images digitally recorded, blindly reviewed, and scored for echogenicity. Association between sonographic appearance, clinicopathologic factors and long-term outcomes was analyzed., Results: A total of 216 lesions from 65 patients were analyzed, with IOUS identifying at least one additional metastasis than preoperative imaging in 41 patients (63.1%) with subsequent change of surgical strategy in 14 patients (21.5%). Most NELM appeared hypoechoic (49.1%) on IOUS, while 38.9% demonstrated hyperechogenicity and 12% isoechogenicity. Hypoechoic lesions were associated with poorly-differentiated tumor (p = 0.005) and smaller tumor size (p = 0.004). Patients with hypoechoic metastases demonstrated significantly shorter median disease-free survival compared with isoechoic or hyperechoic lesions (9 vs 20 vs 18 months, p = 0.049)., Discussion: In addition to improved tumor detection of NELM, IOUS was found to be associated with features of tumor biology, specifically tumor grade and risk-of-recurrence. Echogenicity should be considered a potential prognostic factor in the management of patients with neuroendocrine tumors., (Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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33. Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016.

Author

Chan SL, Chong CC, Chan AW, Poon DM, and Chok KS

Subjects
Chemoembolization, Therapeutic, Combined Modality Therapy, Humans, Stents, Thrombectomy, Venous Thrombosis classification, Carcinoma, Hepatocellular complications, Liver Neoplasms complications, Portal Vein surgery, Venous Thrombosis etiology, Venous Thrombosis therapy
Abstract

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 discuss the recent conceptual changes and summarize the data on the management of HCC with PVTT.

Published
2016
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34. Single-incision laparoscopic cholecystectomy: from four wounds to one.

Author

Wong JS, Cheung YS, Chan KW, Chong CC, Lee KF, Wong J, and Lai PB

Subjects
Adult, Female, Gallstones surgery, Hematoma etiology, Hernia, Abdominal etiology, Humans, Male, Middle Aged, Polyps surgery, Prospective Studies, Time Factors, Treatment Outcome, Urinary Retention etiology, Cholecystectomy, Laparoscopic adverse effects, Gallbladder Neoplasms surgery, Learning Curve
Abstract

Objective: To review the initial results and surgical outcomes of single-incision laparoscopic cholecystectomy., Design: Prospective case series., Setting: A university teaching hospital and a regional hospital in Hong Kong., Patients: All patients undergoing single-incision laparoscopic cholecystectomy from August 2009 to March 2011., Results: Fifty patients underwent single-incision laparoscopic cholecystectomy during the study period. The indications for surgery included symptomatic gallstones (n=43) and gallbladder polyps (n=7). The mean operating time was 78 (standard deviation, 24) minutes. Forty-five of the patients successfully underwent single-incision laparoscopic cholecystectomy, giving a success rate of 90%. In the remaining five patients, additional working ports were constructed to obtain better exposure and dissection around Calot's triangle. On comparing the results of the initial 25 cases to the subsequent 25 cases, in the latter group the operating time was significantly shorter (86 vs 71 minutes; P=0.02), and the success rate was higher (80% vs 100%; P=0.05). During the median follow-up period of 6.8 months, four patients had complications, which included: postoperative urinary retention (n=2), one each with a haematoma and an incisional hernia. No patient endured bile duct injury, postoperative bile leakage, or haemorrhage in our series., Conclusion: Single-incision laparoscopic cholecystectomy is feasible and safe for treatment of uncomplicated gallbladder diseases. There was a reduction in the operating time and increase in success rate with accumulation of experience. Nevertheless, surgeons should be cautious about the potential risks of this new technique.

Published
2011

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