Cheng K.K.F.,National University of Singapore |
Yeung R.M.W.,Pamela Youde Nethersole Eastern Hospital
European Journal of Cancer Care | Year: 2013
This paper describes the prevalence of mood disturbance, sleep disturbance, fatigue and pain (MSFP), either alone or in combination in patients receiving cancer therapy, and determines its impact and whether it is a predictor for functional status and the impairment of quality of life (QoL). This is a cross-sectional study using secondary data from a sample of 214 patients being treated by chemotherapy or radiotherapy. In all, 87%, 68%, 66% and 38% of the patients reported MSFP respectively. Co-occurrence of any three and all of the four symptoms, were reported separately at rates of 29% and 31%. Patients with all four symptoms recorded significantly lower Karnofsky Performance Scale (KPS) scores (mean 77.7 ± 12.9) and QoL scores (mean subscales scores 9.0-17.6) than those with none or up to any three of the symptoms (P < 0.001). Regression of the KPS and QoL scores against the MSFP revealed an increase in the explained variance of 25%, 43%, 27%, 37% and 41% respectively for KPS, physical, emotional, functional and total QoL. The results suggest that MSFP are highly prevalent, whether alone or in combination, in patients receiving cancer therapy, and may negatively influence the patient's functional status and QoL during cancer therapy. © 2012 Blackwell Publishing Ltd.
Li M.K.,Pamela Youde Nethersole Eastern Hospital
Asian journal of endoscopic surgery | Year: 2011
There is still no consensus on the ideal management of common bile duct (CBD) stones. This article aims to review the management of concomitant gallbladder stones and CBD stones in the laparoscopic era. A PubMed database search was performed to identify MEDLINE articles from 1986 to 2010 using the key terms "common bile duct stones,""cholecystectomy,""bile duct exploration,""ERCP" (endoscopic retrograde cholangiography), and "endoscopic sphincterotomy." There were five randomized comparative trials (RCT) comparing sequential preoperative ERCP and laparoscopic cholecystectomy (LC) to laparoscopic common bile duct exploration (LCBDE). Two RCTs showed similar stone clearance rates and shorter hospital stays in the LCBDE group, while three RCTs showed similar stone clearance rates and hospital stays in sequential preoperative ERCP, LC and LCBDE groups. There were two RCTs comparing LCBDE to sequential LC and postoperative ERCP. One showed similar stone clearance rate and shorter hospital stay in LCBDE group, while the other showed similar stone clearance rate and hospital stay. There were three RCTs comparing sequential preoperative ERCP and LC against LC with intraoperative ERCP. All three studies showed similar stone clearance rates and shorter hospital stays in the intraoperative ERCP group. There was only one RCT comparing sequential preoperative ERCP and LC against sequential LC and postoperative ERCP. This showed a similar stone clearance rate and shorter hospital stay in the postoperative ERCP group. Different management approaches of concomitant gallbladder stones and CBD stones were equivalent in efficacy. However, one-stage management had the advantage of providing a shorter hospital stay. © 2011 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.
Lee A.W.M.,Pamela Youde Nethersole Eastern Hospital |
Lin J.C.,Taichung Veterans General Hospital |
Ng W.T.,Pamela Youde Nethersole Eastern Hospital
Seminars in Radiation Oncology | Year: 2012
Management of nasopharyngeal carcinoma is one of the greatest clinical challenges. Appropriate detection is not easy because of its anatomical location; sensitive biomarkers in addition to endoscopic and radiological examinations would be valuable. One useful biomarker (particularly for nonkeratinizing carcinoma) is the plasma level of Epstein-Barr viral deoxyribonucleic acid, and its role as a tool for prognostication and monitoring disease progress is presented. Radiotherapy is the primary treatment modality, and using radiation therapy in combination with chemotherapy is recommended for the treatment of locoregionally advanced tumors. Intensity-modulated radiotherapy techniques with image guidance to ensure setup precision are recommended if resources allow; adaptive replanning should be considered if major deviations from the intended dose distribution occur during the treatment course. Most contemporary series have reported encouraging results, with locoregional control exceeding 90%; the key problem is distant failure. The therapeutic margin is extremely narrow. Although significant reduction of some toxicities (eg, xerostomia) and better quality of life is now achievable especially for early stages, the risk of major late toxicities remains substantial. This review will focus on the primary treatment: the current consensus and controversies in the treatment strategy for different stages, the choice of chemotherapy regimen, and the key factors for improving the therapeutic ratio of radiotherapy will be discussed. Summary of the current achievement and direction for future improvement will be presented. © 2012 Elsevier Inc.
Tung K.L.,Pamela Youde Nethersole Eastern Hospital
Asian journal of endoscopic surgery | Year: 2013
We previously conducted a randomized trial comparing the endo-laparoscopic approach (i.e. placing self-expanding metallic stents followed by laparoscopic resection) and conventional open surgery in the treatment of obstructing left-sided colon cancer. This study is a follow-up of the previous randomized trial and aims to report the long-term outcomes of the two groups. Forty-eight patients from the randomized trial were followed up in an outpatient clinic with regular monitoring. Patients were compared for clinicopathological variables, disease recurrence and survival rates. Clinicopathological details were comparable between the two groups. During the median follow-up periods of 32 months for the open group and 65 months endo-laparoscopic group, no statistically significant difference was observed between the groups in disease recurrence rate, 5-year overall survival (27% vs 48%, P = 0.076) and 5-year disease-free survival rates (48% vs 52%, P = 0.63). Besides being a safe bridge to subsequent elective laparoscopic surgery, preoperative self-expanding metallic stents insertion does not adversely affect oncological outcomes and patient survival. Based on our data, the endo-laparoscopic approach is the treatment of choice for patients presenting with malignant left-sided colonic obstruction. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Lee C.N.,Pamela Youde Nethersole Eastern Hospital
Hong Kong Medical Journal | Year: 2012
Objective To review evidences on the management of patients with motor neuron disease. Data sources PubMed literature searches from January 1982 up to January 2011. Study selection Key words for literature search were "motor neuron disease review (MND)". Only the articles which concentrated on the ventilation, nutrition, cognitive or multidisciplinary approaches for motor neuron disease were included. Case reports were not included in the review. In addition, publications were identified using the World Wide Web from references in these papers. Only articles in English were considered. Data extraction A total of 782 articles were retrieved using the key word search, of which 72 concentrated on ventilation, nutrition, cognitive or multidisciplinary approaches. From these, 43 articles were eventually included and formed the basis of this review. Data synthesis Motor neuron disease is an adult-onset neurodegenerative disease that leads to weakness of limb, bulbar, and respiratory muscles. It displays an ethnic variation in incidence; 90% of cases are sporadic and 10% are familial. New diagnostic criteria have been proposed to increase diagnostic sensitivity. Proper clinical studies, electrophysiology, and neuroimaging are necessary before reaching a diagnosis of motor neuron disease. Riluzole remains the only disease-modifying drug approved for this disease; it prolongs life by 3 to 4 months. Multidisciplinary care units are important in the management of motor neuron disease patients. Non-invasive positive pressure ventilation prolongs life in motor neuron disease patients with respiratory failure. Enteral feeding is usually recommended for affected patients with malnutrition. Cognitive impairment is common in these patients, for whom a formal neuropsychiatric assessment is recommended. Appropriate palliative care is needed for these patients in order to improve their quality of dying. Conclusion Motor neuron disease is an incurable disease, for which a highly effective treatment is still pending. Symptomatic treatment remains the mainstay of management. A multidisciplinary approach embracing advances in non-invasive ventilation and gastrostomy can improve quality of life and extend the survival of motor neuron disease patients.
Lai E.C.H.,Pamela Youde Nethersole Eastern Hospital |
Yang G.P.C.,Pamela Youde Nethersole Eastern Hospital |
Tang C.N.,Pamela Youde Nethersole Eastern Hospital
American Journal of Surgery | Year: 2013
Background: This study aimed at analyzing the perioperative and early survival outcomes of robotic liver resection of hepatocellular carcinoma (HCC). Methods: The study population included a consecutive series of patients with HCC who underwent robotic liver resection at a single center. Results: During the study period, 41 consecutive patients with HCC underwent 42 robotic liver resections. Five resections (11.9%) were carried out for recurrent HCC, and 23.8% (n = 10) were hemihepatectomy procedures. The mean operating time and blood loss was 229.4 minutes and 412.6 mL, respectively. The R0 resection rate was 93%. The hospital mortality and morbidity rates were 0% and 7.1%, respectively. The mean hospital stay was 6.2 days. The 2-year overall and disease-free survival rates were 94% and 74%, respectively. In the subgroup analysis of minor liver resection, when compared with the conventional laparoscopic approach, the robotic group had similar blood loss (mean, 373.4 mL vs 347.7 mL), morbidity rate (3% vs 9%), mortality rate (0% vs 0%), and R0 resection rate (90.9% vs 90.9%). However, the robotic group had a significantly longer operative time (202.7 mins vs 133.4 mins). Conclusions: This study demonstrated the feasibility and safety of robotic surgery for HCC, with favorable short-term outcome. However, the long-term oncologic results remain uncertain. © 2013 Elsevier Inc. All rights reserved.
Lai E.C.,Pamela Youde Nethersole Eastern Hospital
Asian journal of endoscopic surgery | Year: 2013
This article reviews the current status of robot-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy. Searches of MEDLINE and PubMed databases were conducted using the keywords "laparoscopic pancreatectomy," "robotic surgery," "pancreaticoduodenectomy" and "distal pancreatectomy" to find articles published between January 1990 and September 2012. Additional papers were identified by a manual search of the references in key articles. Only cases reports, cohort series and nonrandomized comparative studies were available to validate the outcomes of robotic pancreaticoduodenectomy and distal pancreatectomy. There was no randomized controlled trial comparing the robotic approach to the laparoscopic or open approach. To the best of our knowledge, only four studies have compared the robotic approach and the open approach for pancreaticoduodenectomy, and four studies have been published comparing the robotic approach and the laparoscopic approach for distal pancreatectomy. The data were difficult to interpret because of the heterogeneity of the pathologies and techniques used. Robotic-assisted laparoscopic pancreaticoduodenectomy and distal pancreatectomy for appropriately selected patients can be performed safely, with postoperative complication rates and mortality rate comparable to results observed with laparoscopic or open techniques. Robotic surgical systems also seem to improve the spleen-preservation rate in distal pancreatectomy. The oncologic outcomes have not yet been adequately evaluated. Robotic pancreaticoduodenectomy and distal pancreatectomy are safe and feasible in appropriately selected patients. However, because of uncertainties regarding long-term oncologic outcome, caution should be exercised in assessing the appropriateness of this operation for individual patients. Further randomized and controlled studies are required to support the routine use of the robotic technology for pancreatectomy. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Man Wat W.Z.,Pamela Youde Nethersole eastern Hospital
Therapeutics and Clinical Risk Management | Year: 2014
Paget’s disease of bone is a chronic metabolic bone disease with focal increase in bone turnover. The exact etiology of the disease is uncertain, although genetic and environmental factors are believed to be important. Bisphosphonate is the main class of medication being used to control disease activity via its antiresorptive effect. This review discusses the controversies concerning the use of bisphosphonates in the treatment of Paget’s disease of bone, the efficacy of different bisphosphonates in controlling disease activity, and the possible rare side effects of bisphosphonates. Symptoms are the main indication for treatment in Paget’s disease of bone. As treatment benefts in asymptomatic individuals remain controversial and nonevidence based, the decision to treat these patients should be individualized to their risk and beneft profles. There are several trials conducted to evaluate and compare the efficacy of different regimes of bisphosphonates for treating Paget’s disease of bone. Most trials used biochemical markers rather than clinical symptoms or outcomes as parameters for comparison. Zoledronate is an attractive option as it can achieve high rates of biochemical remission and sustain long duration of suppression by a single dose. Atypical femoral fracture and osteonecrosis of the jaw are two rare and severe side effects reported, possibly related to the use of bisphosphonates in patients with osteoporosis and malignancy-induced hypercalcemia. As the regimes of bisphosphonates used for treating Paget’s disease of bone are different from those two diseases, the risks of developing these two possible side effects are expected to be very low, although this remains unknown. Vitamin D and calcium supplement should be given to patients at risk of vitamin D insuffciency when given zoledronate, as symptomatic hypocalcemia may develop. For those intolerant of bisphosphonates, subcutaneous calcitonin can be used for a limited period due to its associated risk of malignancy. © 2014 Wat.
Cheung T.P.,Pamela Youde Nethersole Eastern Hospital
Asian journal of endoscopic surgery | Year: 2012
INTRODUCTION: Given the limitation of surgical access and instrumentation, pure NOTES technique currently appears challenging for colorectal surgery. As such, we would like to determine the technical feasibility and clinical results of hybrid NOTES right hemicolectomy with transrectal extraction of specimen. MATERIALS AND SURGICAL TECHNIQUE: After the right-sided colon was fully mobilized and vessels ligated, bowel resection and intracorporeal side-to-side ileocolic anastomosis were performed with endostaplers. The Transanal Endoscopic Operations device was inserted transanally. The resected specimen was removed via the Transanal Endoscopic Operations device through an enterotomy made over the anterior wall of the upper rectum. DISCUSSION: The operation was performed on a 42-year-old woman and lasted 120 minutes; blood loss was 30 mL. The patient had an uneventful recovery and was discharged on postoperative day 5. The median pain score was 2 (range, 2-3). Our preliminary experience shows that hybrid NOTES right hemicolectomy is safe and feasible. The technique eliminates the need for mini-laparotomy in patients undergoing laparoscopic right hemicolectomy, and it offers promise in this era of minimally invasive surgery. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.
Leung A.L.,Pamela Youde Nethersole Eastern Hospital
Asian journal of endoscopic surgery | Year: 2014
Laparoscopic colorectal surgery has rapidly developed since the 1980s. Relative to open surgery, it offers the benefits of less invasiveness and earlier recovery. However, when a mini-laparotomy wound is needed to retrieve the specimen, the benefits of minimally invasive surgery may be compromised as a result of pain- and wound-related complications. The introduction of natural orifice transluminal endoscopic surgery (NOTES) makes "scarless" surgery a possibility; pain- and wound-related complications are totally abolished. However, a number of technical issues need to be overcome before this technique can be used widely. The development of natural orifice specimen extraction surgery abandons the need for a specimen-retrieval incision and helps overcome the technical hurdles of NOTES. As a bridge between true "scarless" surgery and conventional laparoscopic surgery, hybrid procedures combining laparoscopic resection and natural orifice specimen extraction surgery currently play an important role in minimally invasive colorectal surgery. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.