Biomedical subjects

Sheung Tat Fan

Publications and source records attributed to Sheung Tat Fan.

113 records · Page 7Linked to original sources

PubMed2002

Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation.

OBJECTIVE: To evaluate the survival results and pattern of recurrence after resection of potentially transplantable small hepatocellular carcinomas (HCC) in patients with preserved liver function, with special reference to the implications for a strategy of salvage transplantation. SUMMARY BACKGROUND DATA: Primary resection followed by transplantation for recurrence or deterioration of liver function has been recently suggested as a rational strategy for patients with HCC 5 cm or smaller and preserved liver function. However, there are no published data on transplantability after HCC recurrence or long-term deterioration of liver function after resection of small HCC in Child-Pugh class A patients. Such data are critical in determining the feasibility of salvage transplantation. METHODS: From a prospective database of 473 patients with resection of HCC between 1989 and 1999, 135 patients age 65 years or younger had Child-Pugh class A chronic liver disease (chronic hepatitis or cirrhosis) and transplantable small HCC (solitary < or =5 cm or two or three tumors < or = 3 cm). Survival results were analyzed and the pattern of recurrence was examined for eligibility for salvage transplantation based on the same criteria as those of primary transplantation for HCC. RESULTS: Overall survival rates at 1, 3, 5, and 10 years were 90%, 76%, 70%, and 35%, respectively, and the corresponding disease-free survival rates were 74%, 50%, 36%, and 22%. Cirrhosis and oligonodular tumors were predictive of worse disease-free survival. Patients with concomitant oligonodular tumors and cirrhosis had a 5-year overall survival rate of 48% and a disease-free survival rate of 0%, which were significantly worse compared with other subgroups. At a median follow-up of 48 months, 67 patients had recurrence and 53 (79%) of them were considered eligible for salvage transplantation. Decompensation from Child-Pugh class A to B or C without recurrence occurred in only six patients. CONCLUSIONS: For Child-Pugh class A patients with small HCC, hepatic resection is a reasonable first-line treatment associated with a favorable 5-year overall survival rate. A considerable proportion of patients may survive without recurrence for 5 or even 10 years; among those with recurrence, the majority may be eligible for salvage transplantation. These data suggest that primary resection and salvage transplantation may be a feasible and rational strategy for patients with small HCC and preserved liver function. Primary transplantation may be a preferable option for the subset of patients with oligonodular tumors in cirrhotic liver in view of the poor survival results after resection.

Adult↗

PubMed2002

Extended hepatic resection for hepatocellular carcinoma in patients with cirrhosis: is it justified?

OBJECTIVE: To evaluate the perioperative outcomes and long-term survival of extended hepatic resection for hepatocellular carcinoma (HCC) in patients with cirrhosis. SUMMARY BACKGROUND DATA: Hepatic resection is a well-established treatment for HCC in cirrhotic patients with preserved liver function and limited disease. However, the role of extended hepatic resection (more than four segments) for HCC in cirrhotic patients has not been elucidated. METHODS: Between 1993 and 2000, 45 consecutive patients with histologically confirmed cirrhosis underwent right or left extended hepatectomy for HCC (group A). Perioperative outcomes and long-term survival of these patients were compared with 161 patients with HCC and cirrhosis who underwent hepatic resection of a lesser extent in the same period (group B). All clinicopathologic and follow-up data were collected prospectively. RESULTS: Group A patients had significantly higher intraoperative blood loss, longer operation time, and longer hospital stay than group B. However, the two groups were similar in overall morbidity and hospital mortality. There were no significant differences in the incidence of liver failure or other complications. The resection margin width was similar between the two groups. Despite significantly larger tumor size in group A compared with group B, long-term survival was comparable between the two groups. CONCLUSIONS: Extended hepatic resection for HCC can be performed in selected cirrhotic patients with acceptable morbidity, mortality, and long-term survival that are comparable to those of lesser hepatic resection. Extended hepatectomy for large HCC extending from one lobe to the other or central HCC critically related to the hepatic veins is justifiable in cirrhotic patients with preserved liver function and adequate liver remnant.

Carcinoma, Hepatocellular↗

PubMed2002

Clinicopathological significance of loss of heterozygosity on chromosome 13q in hepatocellular carcinoma.

PURPOSE: Allelic loss is the most frequently genetic alteration found in hepatocellular carcinoma (HCC). Previous genome-wide studies have indicated that chromosome 13q is one of the most frequently affected chromosomes. However, reports on detailed deletion mapping as well as detailed clinicopathological correlation are scanty. EXPERIMENTAL DESIGN: We performed high-density allelotyping on chromosome 13q in HCC from 60 patients and investigated the correlation between allelic losses on chromosome 13q and the clinicopathological features. RESULTS: Allelic loss at one or more of the 29 microsatellite markers was found in 28 (47%) of the 60 HCCs. Allelic losses were more frequently found in tumors with larger size or in tumors at more advanced tumor stages (P = 0.015 and 0.012, respectively). These two clinicopathological features were also significantly associated with the accumulation of allelic losses in terms of fractional allelic loss index (P = 0.028 and 0.018, respectively). In addition, subchromosomal regions located at 13q12.3-14.1 and 13q32 were found to be significantly associated with advanced tumor stages and larger tumor size, respectively (P = 0.008 and 0.007). CONCLUSIONS: The overall findings suggested that allelic losses on 13q might play an important role in contributing to a more aggressive tumor behavior. Putative tumor suppressor genes might be harbored at 13q12.3-14.1 and 13q32, and inactivation of these genes via allelic losses might enhance tumor progression in HCC.

Adult↗

PubMedDate not supplied

Acute intraoperative hemolysis and hemoglobinuria during radiofrequency ablation of hepatocellular carcinoma.

Radiofrequency ablation is a safe and effective treatment for small primary or secondary liver tumors. Development of new probes has allowed the use of radiofrequency ablation for ablation of tumors > 5 cm in the liver. We present a case of acute intravascular hemolysis and hemoglobinuria during radiofrequency ablation of a large 8-cm hepatocellular carcinoma via laparotomy. The hemolysis was recognized during the operation by change of urine color, and prompt management was initiated to prevent acute renal failure. Literature search revealed that radiofrequency ablation can induce hemolysis in experimental setting, but this is the first clinical report of acute hemolysis during radiofrequency ablation for liver tumors.

Aged↗

PubMedDate not supplied

Repeated resections of extrahepatic metastases after hepatic resection: an aggressive approach to hepatocellular carcinoma.

Survival following curative hepatic resection for hepatocellular carcinoma is limited by a high incidence of recurrence. Resection of extrahepatic recurrences has been shown to prolong survival in selected patients. We report two cases in whom repeated resections of extrahepatic metastases achieved good palliation and survival. The first patient had cerebral, pulmonary and splenic metastases that appeared more than four years following an extended left hepatectomy for a 4-cm hepatocellular carcinoma. Resection of the metastases in the three organs was performed in sequence, and the patient remained alive and asymptomatic 12 months after the metastatic recurrence. The second patient developed pulmonary metastases after an extended right hepatectomy for a 16-cm hepatocellular carcinoma. Following two resections of pulmonary metastases, he was alive and disease-free for seven years. These two cases illustrate that an aggressive surgical approach of repeated resections of extrahepatic recurrences after curative resection of hepatocellular carcinoma can result in long-term survival in selected patients.

Adult↗