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Ng HY, Ko JMY, Lam KO, Kwong DLW, Lo AWI, Wong IYH, Wong CLY, Chan SY, Chan KK, Law TT, Dai W, Fong HCH, Choy FSF, Lo CK, Chen C, Law SYK, Lung ML. Circulating Tumor DNA Dynamics as Prognostic Markers in Locally Advanced and Metastatic Esophageal Squamous Cell Carcinoma. JAMA Surg 2023; 158:1141-1150. [PMID: 37728901 PMCID: PMC10512170 DOI: 10.1001/jamasurg.2023.4395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 09/22/2023]
Abstract
Importance Esophageal squamous cell carcinoma (ESCC) is a deadly disease with frequent recurrence. There are unmet needs for prognostic biomarkers for dynamically monitoring disease progression and detecting minimal residual disease. Objective To examine whether circulating tumor DNA is clinically useful as a prognostic biomarker for ESCC recurrence and patient survival. Design, Setting, and Participants This single-center, population-based cohort study consecutively enrolled 147 patients receiving curative (n = 74) or palliative (n = 73) treatment at the surgery and clinical oncology departments of Queen Mary Hospital in Hong Kong from August 1, 2016, to September 31, 2021. Patients were followed up for 2 years. Plasma samples were collected at different longitudinal time points for a prospective circulating tumor DNA (ctDNA) next-generation sequencing profiling study of 77 actionable genes. Intervention Patients were treated with up-front surgery, neoadjuvant chemoradiotherapy plus surgery with or without adjuvant therapy, or palliative chemotherapy (CT). Main Outcomes and Measures Detection of circulating tumor DNA (ctDNA), progression-free survival (PFS), and overall survival (OS). Results A total of 478 serial plasma samples from 147 patients with locoregional or metastatic ESCC were prospectively analyzed. Among the 74 patients in the curative group (median [range] age, 66 [46-85] years; 56 [76.0%] male), 44 (59.5%) relapsed and 36 (48.6%) died. For patients receiving curative surgical treatment, a high ctDNA level (hazard ratio [HR], 7.84; 95% CI, 1.87-32.97; P = .005) and ctDNA alterations (HR, 5.71; 95% CI, 1.81-17.97; P = .003) at 6 months postoperation were independently associated with poor OS. Among patients receiving neoadjuvant chemoradiotherapy, postneoadjuvant ctDNA alterations were associated with poor PFS (HR, 3.16; 95% CI, 1.17-8.52; P = .02). In the 73 patients in the palliative group (median [range] age, 63 [45-82] years; 63 [86.0%] male), 71 (97.3%) had disease relapse and 68 (93.2%) died. Detectable pre-CT NFE2L2 alterations were independently associated with PFS (HR, 2.99; 95% CI, 1.35-6.61; P = .007) and OS (HR, 28.39; 95% CI, 7.26-111.03; P = 1.52 × 10-6), whereas high ctDNA levels (HR, 2.41; 95% CI, 1.18-4.95; P = .02) and alterations in pre-cycle III ctDNA (HR, 1.99; 95% CI, 1.03-3.85; P = .04) showed weaker associations with PFS. Alterations in pre-CT ctDNA were independently associated with OS (HR, 4.46; 95% CI, 1.86-10.69; P = 7.97 × 10-4). Conclusions and Relevance The findings of this cohort study indicate that prognostic models incorporating ctDNA features are useful in ESCC. Both ctDNA level and NFE2L2 alterations pre-CT and before cycle III were found to be important prognostic factors in palliative groups, and ctDNA alterations after treatment and at 6 months after surgery may define high-risk groups for recurrence in the curative group. High-risk patients can benefit by a timely switch to the next therapeutic options.
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Affiliation(s)
- Hoi Yan Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Josephine Mun Yee Ko
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Ka On Lam
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Dora Lai Wan Kwong
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Anthony Wing Ip Lo
- Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Ian Yu Hong Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Claudia Lai Yin Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Siu Yin Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Kwan Kit Chan
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Tsz Ting Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Wei Dai
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Henry Chun Hung Fong
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Faith Sin Fai Choy
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Chun Kit Lo
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Cancan Chen
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Simon Ying Kit Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Maria Li Lung
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
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Ko JMY, Lam KO, Kwong DLW, Wong IYH, Chan FSY, Wong CLY, Chan KK, Law TT, Chiu KWH, Lam CCS, Wong JC, Fong HCH, Choy FSF, Lo A, Law S, Lung ML. Circulating Tumor Cell Enumeration for Serial Monitoring of Treatment Outcomes for Locally Advanced Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15030832. [PMID: 36765790 PMCID: PMC9913330 DOI: 10.3390/cancers15030832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
We aim to reveal the clinical significance and potential usefulness of dynamic monitoring of CTCs to track therapeutic responses and improve survival for advanced ESCC patients. Peripheral blood (PB) (n = 389) and azygos vein blood (AVB) (n = 13) samplings were recruited prospectively from 88 ESCC patients undergoing curative surgery from 2017 to 2022. Longitudinal CTC enumeration was performed with epithelial (EpCAM/pan-cytokeratins/MUC1) and mesenchymal (vimentin) markers at 12 serial timepoints at any of the pre-treatment, all of the post-treatments/pre-surgery, post-surgery follow-ups for 3-year, and relapse. Longitudinal real-time CTC analysis in PB and AVB suggests more CTCs are released early at pre-surgery and 3-month post-surgery into the circulation from the CTRT group compared to the up-front surgery group. High CTC levels at pre-treatments, 1-/3-month post-surgery, unfavorable changes of CTC levels between all post-treatment/pre-surgery and 1-month or 3-month post-surgery (Hazard Ratio (HR) = 6.662, p < 0.001), were independent prognosticators for curative treatment. The unfavorable pre-surgery CTC status was independent prognostic and predictive for neoadjuvant treatment efficacy (HR = 3.652, p = 0.035). The aggressive CTC clusters were more frequently observed in AVB compared to PB. Its role as an independent prognosticator with relapse was first reported in ESCC (HR = 2.539, p = 0.068). CTC clusters and longitudinal CTC monitoring provide useful prognostic information and potential predictive biomarkers to help guide clinicians in improving disease management.
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Affiliation(s)
- Josephine Mun Yee Ko
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
- Correspondence: (J.M.Y.K.); (S.L.); Tel.: +86-(852)-3917-6931 (J.M.Y.K.); +86-(852)-2255-4774 (S.L.); Fax: +86-(852)-2816-6279 (J.M.Y.K.); +86-(852)-2819-4221 (S.L.)
| | - Ka On Lam
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Dora Lai Wan Kwong
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Ian Yu-Hong Wong
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Fion Siu-Yin Chan
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Claudia Lai-Yin Wong
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Kwan Kit Chan
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Tsz Ting Law
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Keith Wan Hang Chiu
- Department of Diagnostic Radiology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Candy Chi Shan Lam
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Jean Chrysei Wong
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Henry Chun Hung Fong
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Faith Sin Fai Choy
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Andy Lo
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Simon Law
- Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
- Correspondence: (J.M.Y.K.); (S.L.); Tel.: +86-(852)-3917-6931 (J.M.Y.K.); +86-(852)-2255-4774 (S.L.); Fax: +86-(852)-2816-6279 (J.M.Y.K.); +86-(852)-2819-4221 (S.L.)
| | - Maria Li Lung
- Department of Clinical Oncology, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
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Ko JMY, Guo C, Liu C, Ning L, Dai W, Tao L, Lo AWI, Wong CWY, Wong IYH, Chan FSY, Wong CLY, Chan KK, Law TT, Lee NPY, Liu Z, Jiang H, Li Z, Law S, Lung ML. Clonal relationship and alcohol consumption-associated mutational signature in synchronous hypopharyngeal tumours and oesophageal squamous cell carcinoma. Br J Cancer 2022; 127:2166-2174. [PMID: 36261585 PMCID: PMC9726980 DOI: 10.1038/s41416-022-01995-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The patients with dual oesophageal squamous cell carcinoma (ESCC) and hypopharyngeal cancer (HPC) have poor prognosis; their underlying genetic pathogenesis is unclear. We hypothesise that development of synchronous ESCC/HPC depends on multicentricity or independent origin, rather than multifocality due to local or lateral spreading. METHOD Multiple region whole-exome sequencing (M-WES) and clonality analysis were used to assess clonal relationship and spatial inter- or intra-tumour heterogeneity (ITH) in 62 tumour regions from eight dual ESCC/HPC and ten ESCC patients. RESULTS All synchronous ESCC/HPC patients had COSMIC 16 mutation signatures, compared to only 40% ESCC in the current study (p = 0.013) and public data set (n = 165, p = 0.003). This alcohol consumption-related mutation signature 16, commonly involved in multiple alcohol-related cancers, was significantly associated with drinking and alcohol metabolism-related ADH1B rs1229984. The mutational landscape and copy number profiles were completely distinct between the two primary tumours; clonality analysis further suggested the two primary tumours shared no or only one clone accompanying independent subclone evolution. M-WES strategy demonstrated higher sensitivity and accuracy for detection of mutational prevalence and the late branch mutations among different regions in the ESCC tumours, compared to traditional sequencing analysis based on single biopsy strategy. Patients with high ITH assessed by cancer cell fraction analysis after M-WES were significantly associated with both relapse and survival. CONCLUSIONS Our hypothesis-generating M-WES ITH assessment data have implications for prognostication. Collectively, our findings support multicentric independent clonal evolution, the field cancerisation theory, and suggest novel insights implicating an aetiologic role of alcohol metabolism in dual ESCC/HPC carcinogenesis.
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Affiliation(s)
- Josephine Mun-Yee Ko
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Chen Guo
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Conghui Liu
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Lvwen Ning
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Wei Dai
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Lihua Tao
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Anthony Wing-Ip Lo
- grid.415550.00000 0004 1764 4144Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Carissa Wing-Yan Wong
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Ian Yu-Hong Wong
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Fion Siu-Yin Chan
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Claudia Lai-Yin Wong
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Kwan Kit Chan
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Tsz Ting Law
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Nikki Pui-Yue Lee
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Zhichao Liu
- grid.16821.3c0000 0004 0368 8293Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Haoyao Jiang
- grid.16821.3c0000 0004 0368 8293Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Zhigang Li
- grid.16821.3c0000 0004 0368 8293Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Simon Law
- grid.194645.b0000000121742757Department of Surgery, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
| | - Maria Li Lung
- grid.194645.b0000000121742757Department of Clinical Oncology, University of Hong Kong, Hong Kong (Special Administrative Region), People’s Republic of China
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Chiu HY, Law TT, Ng L, Wong KY. Hernia in pregnancy—Does it matter? Surgical Practice 2022. [DOI: 10.1111/1744-1633.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hon Yiu Chiu
- Department of Surgery Queen Mary Hospital Pok Fu Lam Hong Kong
| | - Tsz Ting Law
- Department of Surgery Tung Wah Hospital Sheung Wan Hong Kong
| | - Lily Ng
- Department of Surgery Tung Wah Hospital Sheung Wan Hong Kong
| | - Kin Yuen Wong
- Department of Surgery Tung Wah Hospital Sheung Wan Hong Kong
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Cui TYS, Law TT, Ng L, Wong KY. Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature. Asian J Endosc Surg 2021; 14:529-539. [PMID: 33393194 DOI: 10.1111/ases.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/07/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Spigelian hernia is a rare lateral ventral hernia traditionally repaired through open incision with extensive dissection. Three laparoscopic techniques have been reported in the literature: intraperitoneal onlay mesh (IPOM), transabdominal preperitoneal (TAPP), and total extraperitoneal (TEP). TEP is less popular than the other approaches. We evaluated TEP's safety and effectiveness and compared different laparoscopic techniques. METHODS All patients with Spigelian hernia who had undergone extended TEP (eTEP) repair with mesh in our center from January 2007 to February 2020 were studied. A three-port technique with a preperitoneal space created by telescope at the midline was adopted. A systematic review on laparoscopic mesh repair was performed by searching for "Spigelian hernia" and "laparoscopic" from 1999 to 2019 in the MEDLINE database. RESULTS Seven patients underwent eTEP repair for Spigelian hernia. Five presented with abdominal mass and underwent preoperative imaging. Two were diagnosed incidentally during TEP for inguinal hernia. The mean operative duration was 65 minutes (range, 40-93 minutes). There were no open conversions or intraoperative complications. The mean length of hospital stay was 1.4 days (range, 1-3 days). The mean follow-up period was 44.3 months. One patient developed seroma. There was no recurrence or chronic pain. We identified 197 laparoscopic mesh repairs reported in 41 articles. IPOM (n = 91) was the most popular approach, followed by TAPP (n = 70) and TEP (n = 36). Laparoscopic mesh repair of Spigelian hernia is safe and offers excellent outcomes. CONCLUSION We found the eTEP approach safe and effective for Spigelian hernia repair. IPOM, TAPP, and TEP are comparable.
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Affiliation(s)
| | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Luk Y, Li JYY, Law TT, Ng L, Wong KY. Tension-free mesh repair of inguinal hernia in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 2021; 40:62-66. [PMID: 32063146 DOI: 10.1177/0896860819879596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is the first-line renal replacement therapy for end-stage renal failure patients in Hong Kong. Abdominal wall hernia is a common mechanical complication of PD, and early surgical repair has been advocated to reduce complications. This study aims to review the outcomes of tension-free mesh repair of inguinal hernia in PD patients. METHODS All PD patients who underwent elective repair of inguinal hernia from 2009 to 2015 were identified from a single centre for retrospective analysis. Primary outcomes included surgical complications, perioperative dialysis technique and recurrence. RESULTS Twenty-one patients with a total of 26 inguinal hernia repairs were included in this 7-year retrospective study. All were males, and the mean age was 68 ± 10 years. Diabetic nephropathy (n = 9, 42.9%) and glomerulonephritis (n = 7, 33.3%) were the two most common causes of renal failure. All hernias were detected after the initiation of PD, and the mean duration of PD to hernia detection was 16 months (range 1-65 months). Lichtenstein open mesh repair was performed in all patients. Complications included seroma (n = 3, 11.5%) and ischaemic orchitis (n = 1, 3.8%). There were no mesh infection or recurrence. Twenty patients (95.2%) received intermittent peritoneal dialysis post-operatively and returned to continuous ambulatory PD in 15 to 30 days. Only one patient (4.8%) required bridging haemodialysis due to Tenckhoff catheter blockage. CONCLUSIONS Tension-free mesh repair is associated with low morbidity and low recurrence rates in PD patients. Timely management and close collaboration with renal physicians are essential to continue PD after repair.
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Affiliation(s)
- Yan Luk
- Department of Surgery, Queen Mary Hospital, Hong Kong
| | | | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong
| | - Kin Yuen Wong
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong
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Wong IYH, Lam KO, Chan W, Wong C, So TH, Chan KK, Choi CW, Law TT, Chiu K, Chan FSY, Kwong DLW, Law S. Real-world Scenario: CROSS Regimen as Preoperative Therapy for Oesophageal Squamous Cell Carcinoma. J Gastrointest Surg 2020; 24:1937-1947. [PMID: 32671794 DOI: 10.1007/s11605-020-04704-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative chemoradiation (CROSS regimen) has been widely adopted worldwide. The survival advantage imparted is especially impressive for oesophageal squamous cell carcinoma (OSCC). This study aimed at investigating the efficacy of the CROSS regimen in real-world scenario. METHODS This is a retrospective study of all patients with OSCC intended for preoperative treatment using the CROSS regimen during 2012-2017. Patients were divided into two groups: those within the selection criteria in the CROSS trial and those beyond criteria, namely age > 75 years old, tumour length > 8 cm or clinical M1 stage of lymph node involvement (AJCC 6th edition). Clinical outcome and survival data were compared. RESULTS Eighty-eight patients were included. There were 46 patients in the "CROSS eligible" group and 42 in the "CROSS ineligible" group. By intention-to-treat, the estimated median survival was 24.2 months vs. 12.7 months, respectively (p = 0.047). The results were much inferior compared to that published in the original CROSS trial. Univariable and multivariable analyses showed tumour length and resectability as independent variables affecting survival. DISCUSSION In a real-world scenario, the clinical outcome remains suboptimal and the excellent results in the trial setting were not reproducible in this Asian cohort. Patient selection is one key element accountable for the difference. The efficacy of the CROSS regimen may not be adequate for patients with more advanced disease. The optimal multimodal therapy for this group of patients remains undefined.
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Affiliation(s)
- Ian Yu Hong Wong
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Ka On Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Wendy Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Claudia Wong
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Tsz Him So
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Kwan Kit Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Cheuk Wai Choi
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Tsz Ting Law
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Keith Chiu
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Fion Siu Yin Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Dora Lai Wan Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Simon Law
- Department of Surgery, The University of Hong Kong, Hong Kong, China.
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Luk Y, Chau PL, Law TT, Ng L, Wong KY. Laparoscopic Total Extraperitoneal Groin Hernia Repair in Females: Comparison of Outcomes Between Preservation or Division of the Uterine Round Ligament. J Laparoendosc Adv Surg Tech A 2020; 31:6-10. [PMID: 32609074 DOI: 10.1089/lap.2020.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic repair has been recommended as the method-of-choice of groin hernia repair among women. Whether the round ligament of uterus should be divided to facilitate mesh placement remains controversial. This study aims to review the outcomes of laparoscopic total extraperitoneal (TEP) groin hernia repair in women and to evaluate the impact of division of round ligament. Methods: Consecutive female patients with inguinal or femoral hernias who underwent elective laparoscopic TEP repair at a single institution from 2006 to 2017 were included for retrospective analysis. Primary outcomes were postoperative pain, genital prolapse, and recurrence. Outcomes of patients who had the round ligament divided were further compared with those with round ligament preserved and multivariable adjusted analysis was performed. Results: Sixty-eight patients with a total of 77 TEP repairs were included in the 12-year study period. The mean age was 45 ± 16 years old. Incidental femoral hernia was identified in 4 patients (5.9%). There was 1 (1.3%) recurrence upon mean follow-up of 42.9 ± 37.3 months. The round ligament was divided in 67.5% of patients, and upon multivariable adjusted analysis, there were no statistically significant differences in outcomes in terms of chronic pain (odds ratio [OR] = 2.210, P = .357), paresthesia (OR = 0.241, P = .149), and genital prolapse (OR = 0.327, P = .415) when compared with patients with preserved round ligament. Conclusion: Laparoscopic groin hernia repair in women is associated with low recurrence. Division of round ligament intraoperatively facilitates mesh placement and has minimal impact on clinical outcomes.
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Affiliation(s)
- Yan Luk
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Pui Ling Chau
- Department of Surgery, Ruttonjee Hospital, Wan Chai, Hong Kong SAR, China
| | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong SAR, China
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong SAR, China
| | - Kin Yuen Wong
- Department of Surgery, Tung Wah Hospital, Sheung Wan, Hong Kong SAR, China
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Chung I, Cheung BH, Law TT, Ng KK, Ng L, Wong KY. Laparoscopic versus open repair for small paraumbilical hernia: A retrospective review. Asian J Endosc Surg 2019; 12:306-310. [PMID: 30168291 DOI: 10.1111/ases.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The advantages of laparoscopic surgery for ventral hernia repairs are well documented, but its application for small paraumbilical hernias has been less studied. There is no consensus regarding the best technique. METHODS All patients who had open (suture or mesh) and laparoscopic repair of primary paraumbilical hernia between September 2007 and September 2017 in a single center were identified. Hernial defects of 2 cm or less were included; recurrent hernias were excluded. Primary outcomes included operative time, length of hospital stay, and surgical complications. RESULTS Seventy-seven patients were recruited: 54 (70.1%) had open repair and 23 (29.9%) had laparoscopic repair. Forty-six patients (85%) in the open group had primary suture repair. The mean operative time was significantly shorter in the open group than in the laparoscopic group (27.2 vs 56.1 min, P < 0.05). The length of hospital stay in the open group was significantly shorter than in the laparoscopic group (0.8 vs 1.4 days, P = 0.00). Early complications rates were similar, with wound complications in 5.6% (3/54) of open repair patients and 4.3% (1/23) of laparoscopic repair patients (P = 1.0). Among open repair patients, 19 patients (35.2%) were successfully discharged within 12 h after operation. Two patients (3.7%) in the open simple suture group developed recurrence, but no recurrence was identified in the laparoscopic group; this was not statistically significant (P = 1.0). CONCLUSION The laparoscopic approach is comparable to the open approach in the repair of small paraumbilical hernias. For small paraumbilical hernias, we recommend that laparoscopic repair be reserved for obese patients or those with suspected multiple hernial defects.
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Affiliation(s)
- Iris Chung
- Department of Surgery, Queen Mary Hospital, Hong Kong
| | | | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Ka Kin Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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10
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Kwan Kit Chan D, Siu Yin Chan F, King Hung Tong D, Yu Hong Wong I, Lai Yin Wong C, Ting Law T, Ying Kit Law S. FA01.01: MINIMALLY INVASIVE APPROACH RESULTS IN BETTER OUTCOME COMPARED TO OPEN ESOPHAGECTOMY-A PROPENSITY SCORE MATCHED ANALYSIS. Dis Esophagus 2018; 31:1. [PMID: 30219909 DOI: 10.1093/dote/doy089.fa01.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophagectomy remains the mainstay treatment for esophageal cancer. Minimally invasive techniques have gained popularity in recent years. Whether minimally invasive methods result in equivalent or superior outcome to open esophagectomy or not is still controversial. The aim of the current study is to compare outcomes of minimally invasive and open esophagectomy from a single institution, using propensity score matching to lessen biases. METHODS From 1994-2016, 724 patients with squamous cell cancer of the esophagus who underwent esophagectomy were studied. Data were retrieved from a prospectively collected database. Patients were divided into two groups: 453 had open esophagectomy (open group), and 271 had VATS esophagectomy with gastric mobilization either via laparotomy or laparoscopically (MIE group). A propensity score was generated for each patient based on age, gender, tumor level, use of neoadjuvant therapy, American Society of Anaesthesiologists (ASA) score, pathologic stage of disease, site of anastomosis, and residual tumour (R) categories and the two matched groups were compared in clinico-pathological features, morbidity and mortality rates, and long-term survival. All statistical calculations were performed with SPSS version 24 (SPSS, Chicago, IL). RESULTS A total of 158 patients in MIE and 187 in open group are matched for comparison (1:3 matching). MIE resulted in less blood loss (220 vs 400ml, P < 0.001) but longer operative time (461 vs 305 mins, P < 0.001). Wound infection (3.7% vs 10.7%, P = 0.01) and respiratory complications (29% vs 55.1%, P < 0.001) were also less in MIE group. Except for a higher rate of conduit ischemia (6.3% vs 1.6%, P = 0.02), MIE had comparable surgical outcomes with open technique in rates of anastomotic leakage (5.7% vs 5.3%, P = 0.89), recurrent laryngeal nerve palsy (20.1% vs 18.7%, P = 0.10), reoperation (10.8% vs 8.6%, P = 0.49), and length of postoperative hospital stay (13 vs 14 days, P = 0.50). Lymph node harvest was significantly higher with MIE (35 vs 21, P < 0.001), a longer median survival was also evident compared to the open group (42.3 vs 24.7 months, P = 0.03). CONCLUSION Although requiring longer operative time, MIE led to less wound and respiratory complications without jeopardizing surgical and oncological outcome. The more comprehensive lymphadenectomy could potentially improve prognosis. DISCLOSURE All authors have declared no conflicts of interest.
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Affiliation(s)
| | | | | | | | | | - Tsz Ting Law
- The University of Hong Kong, Hong Kong/HONG KONG PRC
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11
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Law TT, Ng KK, Ng L, Wong KY. Elective laparoscopic totally extraperitoneal repair for Spigelian hernia: A case series of four patients. Asian J Endosc Surg 2018; 11:244-247. [PMID: 29297987 DOI: 10.1111/ases.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spigelian hernia (SH) is uncommon. Clinical diagnosis may be difficult, but computed tomography (CT) can help to establish the diagnosis. Laparoscopic repair is increasingly performed because it is associated with low morbidity rates. Laparoscopic approaches include transabdominal preperitoneal (TAPP), intraperitoneal onlay mesh (IPOM), and totally extraperitoneal (TEP). Here, we report our experiences of TEP repair for SH. METHODS A retrospective review was performed on all patients with SH who underwent elective laparoscopic TEP repair from 2007 to 2017 at Tung Wah Hospital, Hong Kong. RESULTS Four patients with SH were identified in the study period: three with a preoperative diagnosis of SH confirmed by CT scan and one diagnosed incidentally during TEP repair for inguinal hernia. The patients' mean age was 66.8 years (range, 55.0-82.0 years). The mean BMI was 22.8 kg/m2 (range, 20.8-23.6 kg/m2 ). The mean size of the SH defect was 2.0 cm (range, 0.5-3.0 cm). The mean operative time was 59 min (range, 40-86 min). Concomitant direct inguinal hernia was found in one patient and repaired simultaneously. All patients were discharged on postoperative day 1. One patient developed seroma, which subsided on conservative management. At a mean follow-up of 36 months (range, 2-108 months), there was no recurrence. CONCLUSION Laparoscopic repair for SH is preferred over the open approach as it is associated with a low morbidity rate and a short hospital stay. In our experience, TEP technique is safe and effective in laparoscopic SH repair.
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Affiliation(s)
- Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Ka Kin Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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12
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Chan CM, Lai KKY, Ng EKO, Kiang MN, Kwok TWH, Wang HK, Chan KW, Law TT, Tong DK, Chan KT, Lee NP, Law S. Serum microRNA-193b as a promising biomarker for prediction of chemoradiation sensitivity in esophageal squamous cell carcinoma patients. Oncol Lett 2017; 15:3273-3280. [PMID: 29435069 DOI: 10.3892/ol.2017.7698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 08/03/2017] [Indexed: 02/06/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is the most predominantly occurring type of esophageal cancer worldwide. Locally advanced ESCC patients are treated by neoadjuvant chemoradiation for tumor downstaging prior to tumor resection. Patients receiving this treatment have an increased expectation of cure via the following tumor resection and have better survival outcomes. However, not all patients respond well to chemoradiation and poor responders suffer from treatment-associated toxicity and complications without benefits. No method is currently available to predict patient chemoradiation response and to exclude poor responders from ineffective treatment. To address this clinical limitation, the present study aimed to identify non-invasive biomarkers for predicting patient chemoradiation response. Due to the features of microRNA (miRNA) in cancer diagnosis, prognosis and treatment response prediction, serum miRNA arrays were performed to identify potential miRNA(s) that may be used for chemoradiation response prediction in ESCC. Using an miRNA array to compare pre-treatment serum sample pools from 10 good responders and 10 poor responders, the present study identified miR-193b, miR-942 and miR-629* as candidate miRNAs for predicting chemoradiation response. Subsequent validation using reverse transcription-quantitative polymerase chain reaction confirmed that miR-193b, however not miR-942 and miR-629*, were significantly increased in sera from 24 good responders, compared with 23 poor responders. Further analyses using the receiver operating characteristic curve revealed a strong predictive power of serum miR-193b on discriminating good responders from poor responders to chemoradiation. In addition, a high serum level of miR-193b was significantly associated with better survival outcomes. Therefore, serum miR-193b may be considered a promising biomarker for predicting chemoradiation response and post-therapy survival of ESCC patients.
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Affiliation(s)
- Chung Man Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Kenneth K Y Lai
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Enders K O Ng
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Mei Na Kiang
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Tiffany W H Kwok
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Hector K Wang
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Kwok Wah Chan
- Department of Pathology, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Tsz Ting Law
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Daniel K Tong
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Kin Tak Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Nikki P Lee
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Simon Law
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
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Law TT, Chan JY, Chan DK, Tong D, Wong IY, Chan FS, Law S. Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies. Hong Kong Med J 2017; 23:231-8. [PMID: 28278490 DOI: 10.12809/hkmj164942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment. METHODS We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed. RESULTS We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaave's syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, <0.01, and <0.01, respectively). CONCLUSIONS Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.
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Affiliation(s)
- T T Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - J Yl Chan
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - D Kk Chan
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - D Tong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - I Yh Wong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - F Sy Chan
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Zhu RY, Law TT, Tong D, Tam G, Law S. Spontaneous circumferential intramural esophageal dissection complicated with esophageal perforation and esophageal-pleural fistula: a case report and literature review. Dis Esophagus 2016; 29:872-879. [PMID: 24602017 DOI: 10.1111/dote.12200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous intramural esophageal dissection (IED) is a rare disease entity. There are few reports of spontaneous IED requiring surgical treatment. Hereby, we report a 37-year-old gentleman who was diagnosed to have spontaneous extensive circumferential IED complicated with esophageal perforation, empyema, and esophageal-pleural fistula. Esophageal stenting and drainage of empyema were unsuccessful. Computed tomography and gastrografin contrast swallow demonstrated a leak to the pleural cavity, suggestive of esophageal-pleural fistula. Subsequently, a two-stage operation was performed: cervical esophagogastrostomy to bypass the perforated esophagus, followed by esophagectomy and decortication of the right lung. The patient recovered and was discharged home after a 3-week hospitalization. The management principles and recent published literature related to IED were reviewed.
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Affiliation(s)
- R Y Zhu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - T T Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - D Tong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - G Tam
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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15
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Yu VZ, Wong VCL, Dai W, Ko JMY, Lam AKY, Chan KW, Samant RS, Lung HL, Shuen WH, Law S, Chan YP, Lee NPY, Tong DKH, Law TT, Lee VHF, Lung ML. Nuclear Localization of DNAJB6 Is Associated With Survival of Patients With Esophageal Cancer and Reduces AKT Signaling and Proliferation of Cancer Cells. Gastroenterology 2015; 149:1825-1836.e5. [PMID: 26302489 DOI: 10.1053/j.gastro.2015.08.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The DnaJ (Hsp40) homolog, subfamily B, member 6 (DNAJB6) is part of a family of proteins that regulates chaperone activities. One of its isoforms, DNAJB6a, contains a nuclear localization signal and regulates β-catenin signaling during breast cancer development. We investigated the role of DNAJB6 in the pathogenesis of esophageal squamous cell carcinoma (ESCC). METHODS We performed immunohistochemical analyses of primary ESCC samples and lymph node metastases from a cohort of 160 patients who underwent esophagectomy with no preoperative chemoradiotherapy at Hong Kong Queen Mary Hospital. Data were collected on patient outcomes over a median time of 12.1 ± 2.9 months. Retrospective survival association analyses were performed. Wild-type and mutant forms of DNAJB6a were overexpressed in cancer cell lines (KYSE510, KYSE 30TSI, KYSE140, and KYSE70TS), which were analyzed in proliferation and immunoblot assays, or injected subcutaneously into nude mice. Levels of DNAJB6 were knocked down in ESCC cell lines (KYSE450 and T.Tn), immortalized normal esophageal epithelial cell lines (NE3 and NE083), and other cells with short hairpin RNAs, or by genome engineering. Bimolecular fluorescence complementation was used to study interactions between proteins in living cells. RESULTS In primary ESCC samples, patients whose tumors had high nuclear levels of DNAJB6 had longer overall survival times (19.2 ± 1.8 months; 95% confidence interval [CI], 15.6-22.8 mo) than patients whose tumors had low nuclear levels of DNAJB6 (12.6 ± 1.4 mo; 95% CI, 9.8-15.4 mo; P = .004, log-rank test). Based on Cox regression analysis, patients whose tumors had high nuclear levels of DNAJB6 had a lower risk of death than patients with low levels (hazard ratio, 0.562; 95% CI, 0.379-0.834; P = .004). Based on log-rank analysis and Cox regression analysis, the combination of the nuclear level of DNAJB6 and the presence of lymph node metastases at diagnosis could be used to stratify patients into groups with good or bad outcomes (P < .0005 for both analyses). There was a negative association between the nuclear level of DNAJB6 and the presence of lymph node metastases (P = .022; Pearson χ(2) test). Cancer cell lines that overexpressed DNAJB6a formed tumors more slowly in nude mice than control cells or cells that expressed a mutant form of DNAJB6a that did not localize to the nucleus. DNAJB6 knockdown in cancer cell lines promoted their growth as xenograft tumors in mice. A motif of histidine, proline, and aspartic acid in the J domain of DNAJB6a was required for its tumor-suppressive effects and signaling via AKT1. Loss of DNAJB6a resulted in up-regulation of AKT signaling in cancer cell lines and immortalized esophageal epithelial cells. Expression of a constitutively active form of AKT1 restored proliferation to tumor cells that overexpressed DNAJB6a, and DNAJB6a formed a complex with AKT1 in living cells. The expression of DNAJB6a reduced the sensitivity of ESCC to AKT inhibitors; the expression level of DNAJB6a affected AKT signaling in multiple cancer cell lines. CONCLUSIONS Nuclear localization of DNAJB6 is associated with longer survival times of patients with ESCC. DNAJB6a reduces AKT signaling, and DNAJB6 expression in cancer cells reduces their proliferation and growth of xenograft tumors in mice. DNAJB6a might be developed as a biomarker for progression of ESCC.
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Affiliation(s)
- Valen Zhuoyou Yu
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Victor Chun-Lam Wong
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Wei Dai
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Josephine Mun-Yee Ko
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Alfred King-Yin Lam
- Department of Cancer Molecular Pathology, Griffith Medical School and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kwok Wah Chan
- Department of Pathology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Rajeev S Samant
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hong Lok Lung
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Wai Ho Shuen
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Simon Law
- Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Yuen Piu Chan
- Department of Pathology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Nikki Pui-Yue Lee
- Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Daniel King Hung Tong
- Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Tsz Ting Law
- Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region
| | - Maria Li Lung
- Department of Clinical Oncology, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region; Center for Cancer Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong, Special Administrative Region.
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Law TT, Tong D, Wong SWH, Chan SY, Law S. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: magnifying endoscopy findings. Hong Kong Med J 2015; 21:183-6. [PMID: 25904569 DOI: 10.12809/hkmj134208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gastric mucosa-associated lymphoid tissue lymphoma is uncommon and most patients have an indolent clinical course. The clinical presentation and endoscopic findings can be subtle and diagnosis can be missed on white light endoscopy. Magnifying endoscopy may help identify the abnormal microstructural and microvascular patterns, and target biopsies can be performed. We describe herein the case of a 64-year-old woman with Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma diagnosed by screening magnification endoscopy. Helicobacter pylori-eradication therapy was given and she received biological therapy. She is in clinical remission after treatment. The use of magnification endoscopy in gastric mucosa-associated lymphoid tissue lymphoma and its management are reviewed.
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Affiliation(s)
- T T Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Daniel Tong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sam W H Wong
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S Y Chan
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Simon Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Abstract
(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has established itself as an important imaging modality in many oncological and nononcological specialties and, as a consequence, it is increasingly being used in clinical practice. Since the first report of FDG being taken up by metastatic differentiated thyroid carcinoma (DTC) cells >20 years ago, various groups of investigators have explored the potential role of FDG-PET scanning in patients with benign and malignant thyroid neoplasms. With the increasing demand for FDG-PET scanning, clinicians are faced with the challenge of managing an increasing number of FDG-PET-detected thyroid incidentalomas because their significance remains unclear. The aims of this review are to address some of these issues, specifically, the clinical significance of FDG-PET-detected thyroid incidentalomas, the ability of FDG-PET to characterize thyroid nodules, especially those with indeterminate fine needle aspiration cytology results, and the role of FDG-PET in patients with confirmed primary DTC and with suspected recurrent DTC, by reviewing the current literature.
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18
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Law TT, Suen DTK, Tam YF, Cho SY, Chung HP, Kwong A, Yuen WK. Telephone pre-anaesthesia assessment for ambulatory breast surgery. Hong Kong Med J 2009; 15:179-182. [PMID: 19494372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To review the efficacy of telephone preoperative anaesthesia assessment in patients undergoing ambulatory breast surgery. DESIGN Retrospective study. SETTING Day Surgery Centre, Tung Wah Hospital, Hong Kong. PATIENTS Patients with breast lumps to be excised were seen by dedicated breast surgeons and informed of day procedures and preoperative anaesthesia assessment. Those who fulfilled the selection criteria of age (18-45 years) and American Society of Anesthesiologists grade I were recruited for telephone anaesthesia assessment preoperatively. The patients were contacted by senior day surgery nurses via telephone before the scheduled operation date, and information was retrieved using a standard assessment form. Prospective data from January 2002 to December 2007 were analysed. MAIN OUTCOME MEASURES Proportion of patients who successfully underwent day surgery after telephone preoperative anaesthesia assessment. RESULTS Of 482 patients receiving ambulatory surgery for breast lumps during the study period, 283 patients were selected for preoperative telephone anaesthesia assessment. Five (2%) patients with problems identified by this method underwent further assessment at the Day Surgery Centre; the remaining 278 (98%) required no further assessment and proceeded to have a successful day surgery procedure. CONCLUSION Preoperative anaesthesia assessment by telephone is an effective means of preoperative assessment in selected patients undergoing ambulatory breast surgery.
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Affiliation(s)
- T T Law
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong
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