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Chung-Mau Lo

Publications and source records attributed to Chung-Mau Lo.

49 records · Page 3Linked to original sources
PubMed2003

Safety and necessity of including the middle hepatic vein in the right lobe graft in adult-to-adult live donor liver transplantation.

OBJECTIVE: To evaluate the safety of donors who have donated the middle hepatic vein in right lobe live donor liver transplantation (LDLT) and to determine whether such inclusion is necessary for optimum graft function. SUMMARY BACKGROUND DATA: The necessity to include the middle hepatic vein in a right lobe graft in adult-to-adult LDLT is controversial. Inclusion of the middle hepatic vein in the graft provides uniform hepatic venous drainage but may lead to congestion of segment IV in the donor. METHODS: From 1996 to 2002, 93 right-lobe LDLTs were performed. All right-lobe grafts except 1 contained the middle hepatic vein. In the donor operation, attention was paid to preserve the segment IV hepatic artery and to avoid prolonged rotation of the right lobe. The middle hepatic vein was transected proximal to a major segment IVb hepatic vein whereas possible to preserve the venous drainage in the liver remnant. RESULTS: There was no donor death. Two donors had intraoperative complications (accidental left hepatic vein occlusion and portal vein thrombosis) and were well after immediate rectification. Twenty-four donors (26%) had postoperative complications, mostly minor wound infection. The postoperative international normalized ratio on day 1 was better in the donors with preservation of segment IVb hepatic vein than those without the preservation, but, in all donors, the liver function was largely normal by postoperative day 7. The first recipient had severe graft congestion as the middle hepatic vein was not reconstructed before reperfusion. In 7 other recipients, the middle hepatic vein was found occluded intraoperatively owing to technical errors. The postoperative hepatic and renal function of the recipients with an occluded or absent middle hepatic vein was worse than those with a patent middle hepatic vein. The hospital mortality rate was also higher in those with an occluded middle hepatic vein (3/9 vs. 5/84, P = 0.028). CONCLUSIONS: Inclusion of the middle hepatic vein in right-lobe LDLT is safe and is essential for optimum graft function and patient survival.

Adult↗
PubMed2003

Determinants of hospital mortality of adult recipients of right lobe live donor liver transplantation.

OBJECTIVE: To define the technical factors that might contribute to hospital mortality of recipients of right lobe live donor liver transplantation (LDLT) so as to perfect the design of the operation. SUMMARY BACKGROUND DATA: Right lobe LDLT has been accepted as one of the treatments for patients with terminal hepatic failure, but the design and results of the reported series vary and the technical factors affecting hospital mortality have not been known. METHODS: The data of 100 adult-to-adult right lobe LDLT performed between 1996 and 2002 were prospectively collected and retrospectively analyzed. All grafts except one contained the middle hepatic vein, which was anastomosed to the recipient middle/left hepatic vein in the first 84 recipients and directly into the inferior vena cava (with the right hepatic vein in form of venoplasty) in the subsequent 15 patients. Venovenous bypass was used routinely in the first 29 patients but not subsequently. RESULTS: Eight patients died within the same hospital admission for liver transplantation. There was no hospital mortality in the last 53 recipients. Comparison of data of patients with or without hospital mortality showed that graft weight/body weight ratio, graft weight/estimated standard liver weight ratio, technical error resulting in occlusion/absence of the middle hepatic vein, use of venovenous bypass, the lowest body temperature recorded during surgery, the volume of intraoperative blood transfusion, fresh frozen plasma, and platelet infusion were significantly different between the two groups. However, the pretransplant intensive care unit status of the recipients, cold and warm ischemic time of the graft, and occurrence of biliary complications were not. By multivariate analysis, low body temperature recorded during operation, low graft weight/estimated standard liver weight ratio (</=0.35), and the middle hepatic vein occlusion were independent significant factors in determining hospital mortality. CONCLUSIONS: To achieve a uniformly successful right lobe LDLT, the right lobe graft must contain a patent middle hepatic vein. With a completely patent middle hepatic vein, a graft size of >35% of the estimated standard graft weight may be sufficient for recipient survival. Hypothermia, which predisposes to coagulopathy and is enhanced by the use of venovenous bypass and massive blood, and blood product transfusion must be avoided.

Adolescent↗
PubMed2003

Hepatic resection for combined hepatocellular and cholangiocarcinoma.

HYPOTHESIS: Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is an uncommon form of primary liver cancer with features of hepatocellular and biliary epithelial differentiation. The clinical significance of this disease entity is poorly understood. The aim of the present study was to determine the operative and survival outcomes of patients with HCC-CC who underwent hepatic resection. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: The study comprised 12 patients (aged 28-72 years) with HCC-CC (HCC-CC group) who underwent hepatic resection between January 1, 1991, and December 31, 2000. The diagnosis was based on a combination of histological, immunohistochemical, and, if necessary, electron microscopic examinations of the resected specimen. MAIN OUTCOME MEASURES: Clinicopathological data and operative and survival outcomes of the HCC-CC group were compared with those of 476 patients with HCC (HCC group) and 25 patients with intrahepatic CC (CC group) who underwent hepatic resection during the study period. RESULTS: Ten patients (83%) in the HCC-CC group underwent major hepatic resection. The operative morbidity and mortality were 17% (2 of 12 patients) and 0%, respectively. The clinicopathological variables of the HCC-CC group resembled those of the HCC group more closely than those of the CC group. The incidence of positive hepatitis B serologic test results in the HCC-CC group (7 [58%] of 12 patients) was intermediate between that of the HCC group (392 [82%] of 476 patients) and that of the CC group (5 [20%] of 25 patients) (P<.001). Underlying chronic liver disease was significantly less common in the CC group (5 [20%] of 25 patients) than in either the HCC-CC group (9 [75%] of 12 patients) or the HCC group (421 [88%] of 476 patients) (P<.001). After hepatic resection, the median disease-free survival of the HCC-CC, HCC, and CC groups was 10, 18, and 24 months, respectively (P =.44). The overall median survival was shortest in the HCC-CC group (17 months) and was not significantly different from that of the CC group (26 months) (P =.38), but was significantly worse than that of the HCC group (52 months) (P =.02). CONCLUSIONS: Although the clinicopathological variables of patients with HCC-CC were most similar to those of patients with HCC, patients with HCC-CC had a significantly worse survival outcome after hepatic resection when compared with patients with HCC. Further studies on postoperative adjuvant therapy and multimodality treatment for recurrent disease are required to prolong the survival of these patients.

Adult↗
PubMed2003

Hepatic resection for bilobar hepatocellular carcinoma: is it justified?

HYPOTHESIS: Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliative hepatic resection in selected patients with advanced HCC may result in a favorable survival outcome. The aim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B). MAIN OUTCOME MEASURES: The clinicopathologic data and operative and survival outcomes of both groups of patients were compared. RESULTS: The clinicopathologic parameters were comparable in both groups of patients. In group A, 12 patients (80%) underwent major hepatic resection, and the mean +/- SEM size of the resected tumors was 8.3 +/- 0.9 cm. The operative morbidity and mortality were 20% and 0%, respectively. Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization (3 patients). In group B, treatment for HCC included transarterial oily chemoembolization (42 patients), systemic chemotherapy (3 patients), transarterial oily chemoembolization and systemic chemotherapy (5 patients), cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5 months, with 4 patients surviving for more than 3 years. The survival in group A was significantly better than in group B (median = 7.1 months; P =.008). On multivariate analysis, hepatic resection and preoperative serum alpha-fetoprotein level were the 2 independent factors that significantly affected patient survival. CONCLUSIONS: Hepatic resection for HCC in patients with stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.

Adolescent↗
PubMed2002

Intraoperative iatrogenic rupture of hepatocellular carcinoma.

Intraoperative iatrogenic rupture of hepatocellular carcinoma (HCC), which can occur during hepatic resection when large tumors are being mobilized, may adversely affect the operative outcome. Little information is available in the literature on this serious intraoperative complication. The aim of the present study is to document iatrogenic rupture of HCC as a serious complication during hepatic resection and its effects on the operative and long-term outcomes of patients with this complication. A retrospective study was performed on all patients with intraoperative iatrogenic rupture of HCC during hepatic resection from 1989 to 1997, and the operative and long-term survival outcomes were compared with those of patients without the complication. Among 194 patients who underwent hepatic resection for a large HCC (> or =5 cm) during the study period, 8 (4.1%) had intraoperative iatrogenic rupture of the tumor. When compared with 186 patients with similar clinical parameters but without intraoperative rupture, patients with intraoperative rupture had significantly more intraoperative blood loss (median 5.7 vs. 2.0 L;p = 0.01) and blood transfusion requirement (median 3.1 vs 0.9 L; p = 0.02). On follow-up, patients in the intraoperative rupture group had a significantly higher intraperitoneal extrahepatic recurrence rate (33.3% vs. 2.9%; p =0.02) and significantly shorter survival (median 11.5 vs. 37.9 months,p = 0.04) when compared with patients without the complication. Intraoperative iatrogenic rupture is a serious complication of hepatic resection for HCC because it is associated with increased intraoperative blood loss, increased incidence of intraperitoneal extrahepatic recurrence, and short survival. Extreme care should be taken during mobilization of the tumor, and an alternative operative approach in the presence of a difficult hepatic resection of a large HCC may be required to avoid the complication.

Adult↗
PubMed2002

Choledochal cysts in adults.

HYPOTHESIS: Choledochal cyst is rarely diagnosed in adulthood. When complicated by biliary tract malignancy, the disease has a distinct presentation and carries a dismal prognosis despite radical surgical resection. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: A retrospective study was performed on 30 adult patients who presented with choledochal cyst from January 1, 1989, to December 31, 2000. MAIN OUTCOME MEASURES: The clinical presentation, management, and outcome of patients with and without biliary tract malignancy. RESULTS: Nine patients (30%) had biliary tract malignancy complicating choledochal cyst (group A). Compared with 21 patients without malignancy (group B), group A patients had a significantly higher incidence of previous internal drainage operations for choledochal cyst (P =.049) and presentation with cholangitis (P =.03). Four patients in group A underwent pancreaticoduodenectomy and 3 received a palliative biliary drainage operation. The overall median survival of patients in group A was 12 months. Complete excision of choledochal cyst and Roux-en-Y hepaticojejunostomy were performed for all patients in group B, among whom 2 underwent concomitant hemihepatectomy. The operative morbidity and mortality were 14% and 0%, respectively, and there were no long-term complications with a median follow-up of 66 months. CONCLUSIONS: Biliary tract malignancy complicating choledochal cyst in adults should be suspected in patients with a history of internal drainage of choledochal cyst and presentation with cholangitis. Complete excision of choledochal cyst with Roux-en-Y hepaticojejunostomy is the treatment of choice for patients without malignancy and can be performed with low operative morbidity and absence of long-term complications in adult patients.

Adolescent↗
PubMed2002

Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma.

This randomized, controlled trial assessed the efficacy of transarterial Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-Sous-Bois, France) chemoembolization in patients with unresectable hepatocellular carcinoma. From March 1996 to October 1997, 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and randomly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery (chemoembolization group, 40 patients) or symptomatic treatment (control group, 40 patients). One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis. Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease. Survival was the main end point. The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 (range, 1-15) courses per patient. Chemoembolization resulted in a marked tumor response, and the actuarial survival was significantly better in the chemoembolization group (1 year, 57%; 2 years, 31%; 3 years, 26%) than in the control group (1 year, 32%; 2 years, 11%; 3 years, 3%; P =.002). When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model, the survival benefit of chemoembolization remained significant (relative risk of death, 0.49; 95% CI, 0.29-0.81; P =.006). Although death from liver failure was more frequent in patients who received chemoembolization, the liver functions of the survivors were not significantly different. In conclusion, in Asian patients with unresectable hepatocellular carcinoma, transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment.

Aged↗
PubMed2002

A randomized placebo-controlled study of long-acting octreotide for the treatment of advanced hepatocellular carcinoma.

Although various types of treatment of hepatocellular carcinoma (HCC) have been tried, the prognosis remains dismal, especially in patients with advanced stage of the disease. Somatostatin analogues exert antitumor effects. HCC have been shown to exhibit somatostatin receptors. The present randomized placebo-controlled study aimed at examining the efficacy of long-acting octreotide (Sandostatin LAR) for the treatment of advanced HCC. Seventy patients were randomized to receive a 2-week course of 250 microg short-acting octreotide twice daily followed by Sandostatin LAR 30 mg injection once every 4 weeks for 6 doses (n = 35) or placebo (control group) (n = 35). The clinical and laboratory parameters were monitored. There was no difference in the cumulative survival between the Sandostatin LAR-treated group compared with the control group [median survival 1.93 months vs. 1.97 months, respectively, P = NS (log-rank test)]. There was no tumor regression and no reduction of alpha-fetoprotein (AFP) levels in patients receiving Sandostatin LAR treatment. There was no improvement of quality of life assessed by Karnofsky performance score. In conclusion, Sandostatin LAR monotherapy did not have survival benefit in our selected group of patients with advanced HCC. Further studies should be performed in patients with less advanced disease and/or different etiology to evaluate its benefit.

Adult↗
PubMed2002

Biliary reconstruction and complications of right lobe live donor liver transplantation.

OBJECTIVE: To identify the possible reasons of failure of biliary reconstruction in right lobe live donor liver transplantation (LDLT) and to devise the best method of reconstruction and treatment strategy for the complications. SUMMARY BACKGROUND DATA: Right lobe LDLT was associated with a high biliary complication rate (15-64%) in the reported series. The causes of failure were not completely understood and the best treatment strategy has not been defined. METHODS: From 1996 to 2001, 74 patients received right lobe LDLT. The operative procedures of the first 37 patients were critically reviewed to identify the possible reasons of leakage or stenosis from the anastomosis. The causes included right hepatic duct ischemia, double or triple hepaticojejunostomies, unrecognized branch of right hepatic duct, jejunal opening smaller than the size of right hepatic duct, and ductal plasty without division of newly created septum. The second 37 patients had biliary reconstruction by a modified technique that preserved blood supply to the right hepatic duct and aimed at avoidance of risk factors. RESULTS: The overall complication rate decreased from 43% in the first 37 patients to 8% in the second 37 patients. There was no leakage from the anastomosis in the second group of patients. Percutaneous transhepatic biliary drainage (PTBD) for the biliary complications resulted in right portal vein and hepatic artery injury in four patients and accounted for mortality in three of them. To avoid complications from PTBD, three patients in the second group developing stenosis of hepaticojejunostomy had repeated hepaticojejunostomy without preoperative PTBD and recovered. CONCLUSIONS: With identification of risk factors and modification of the surgical technique, the complication rate of biliary reconstruction of right lobe LDLT could be reduced. Repeated hepaticojejunostomy without preoperative PTBD is the preferred approach once a complication develops.

Anastomosis, Surgical↗
PubMed2002

Experience of donor right lobe hepatectomy in adult-to-adult live donor liver transplantation: clinical analysis of 89 cases.

OBJECTIVE: To review the experience of donor selection and right lobe hepatectomy in adult-to-adult live donor liver transplantation. METHODS: From May 1996 to December 2001, 89 live donor liver transplants using right lobe grafts were performed at Queen Mary Hospital, Hong Kong. All donors had received psychological counseling before donor operations. They were screened by laboratory tests including complete blood cell count, liver and renal biochemistry, and viral serology studies. Computed tomography (CT), CT volumetry and hepatic arteriography were routinely performed. All donors underwent the operations using the method designed by us. RESULTS: The median duration of the operations was 8.8 hours. The median blood loss recorded 466 ml. The median intensive care unit and hospital stays were 2 and 10 days, respectively. There was no donor mortality. Complications of donor operations included wound infection, urinary tract infection, biliary stricture, cholestasis, subphrenic collection, bowel obstruction and incision hernia, etc. All donors have recovered and returned to their previous occupations. CONCLUSIONS: Live donation of right lobe grafts for adult-to-adult liver transplantation is safe, provided that donor selection is strict and utmost care is exercised during the operation.

Adult↗
PubMed2002

Hepatic stress gene expression and ultrastructural features under intermittent Pringle manoeuvre.

BACKGROUND: Intermittent Pringle manoeuvre resulted in less blood loss and better preservation of liver function when it was applied for fewer than 120 minutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic diseases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle manoeuvre. METHODS: From July 1995 to February 1998, 131 patients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of hepatic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron microscopic examination. RESULTS: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-alpha and interleukin-6) were detected simultaneously in the patients with or without intermittent Pringle manoeuvre. The patients under intermittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induction of TNF-alpha and interleukin-6 genes, which contributed to ischaemia-reperfusion injury and postoperative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the electron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeuvre whatever the liver status, even when the accumulated ischaemic duration was extended to 120 min. CONCLUSION: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultrastructure.

Gene Expression↗
PubMedDate not supplied

Split liver transplantation for two adult recipients.

We report a case of split liver transplantation for two adult recipients. The liver graft (1285 g) was split on the backtable into a right lobe graft (900 g, containing the inferior vena cava and middle hepatic vein) and a left lobe graft (385 g). The right lobe graft was implanted into a patient with hepatitis B cirrhosis uneventfully. The left lobe graft was implanted into a patient with familial amyloid polyneuropathy, but was met with massive bleeding from the transection surface and congestion of segment 4. The dusky appearance of segment 4 disappeared after hepatic artery anastomosis, but Doppler ultrasonography showed reverse blood flow in the segment 4 portal vein. Both patients survived the operation. The case illustrated that a left lobe graft without the middle hepatic vein could be problematic. To benefit two adults with chronic liver diseases, a better design of hepatic vein drainage of segment 4 in the left lobe graft and segment 5 and 8 in the right lobe graft is required.

Adult↗