Publications by authors named "Tiing Foong Siow"
Background: Anatomical liver resection is the gold standard for hepatocellular carcinoma (HCC), enhancing survival and disease-free outcomes. For centrally located tumors, major resections are necessary but risky, especially for patients with liver disease. Central hepatectomy (CH) offers a parenchymal-sparing alternative to extended or hemihepatectomy (HH), reducing postoperative liver failure risk.
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- The study aimed to create global benchmark outcome indicators for laparoscopic right posterior sectionectomies (L-RPS/H67) to improve surgical standards.
- It analyzed data from 854 patients across 57 centers globally, establishing key performance benchmarks for low-risk cases based on specific outcome indicators.
- The findings set standard benchmarks for metrics like operation time and complication rates, serving as a reference for surgical auditing and improvement.
Article Synopsis
- This study assessed how liver cirrhosis (LC) influences the challenges of minimally invasive liver resection (MILR), specifically for minor surgeries involving primary liver tumors in anterolateral segments.
- Conducted from 2004 to 2021 across 60 centers, the research involved 3,675 patients, with varying degrees of cirrhosis classified as Child A and Child B.
- Results indicated that patients with Child A cirrhosis faced higher risks of complications, such as increased blood loss and rates of open conversion, while those with Child B cirrhosis had longer hospital stays and more significant morbidity; overall, the severity of LC complicates the surgical process, highlighting the need for better difficulty
Article Synopsis
- Minimally invasive liver resections (MILR) can reduce blood loss and recovery time compared to traditional methods, but the impact of cirrhosis on these procedures is not fully understood.
- A study reviewed data from 2534 patients who underwent minimally invasive major liver surgeries worldwide, focusing on outcomes related to different levels of cirrhosis.
- Results showed that advanced cirrhosis leads to higher blood transfusion rates, more postoperative complications, and longer hospital stays, suggesting that cirrhosis severity should be considered in future assessments of surgical difficulty in MILR.*
Article Synopsis
- The study investigates how cirrhosis and portal hypertension (PHT) affect the complexity and outcomes of minimally invasive liver surgery in specific liver segments.
- It examines a large patient group, revealing that those with cirrhosis experienced more complications and required more blood transfusions during surgery.
- The findings suggest that the presence of cirrhosis and PHT should be considered when evaluating the difficulties and risks associated with minimally invasive liver resections.
Article Synopsis
- Tumor size (TS) impacts intraoperative outcomes in laparoscopic major hepatectomy (L-MH), with this study aiming to clarify its effects and find optimal TS cutoffs for assessing surgical difficulty.
- The analysis, which included 1396 patients from a larger pool of 3008 undergoing L-MH, identified two critical TS cutoffs at 50 mm and 100 mm that segmented patients into three distinct groups.
- Results showed that larger TS correlated with increased open conversion rates, longer operation times, higher blood loss, and more intraoperative blood transfusions, while postoperative complications remained similar across the groups.
Article Synopsis
- This study aimed to compare outcomes of robotic limited liver resections (RLLR) and laparoscopic limited liver resections (LLLR) for tumors in the posterosuperior liver segments, noting that previous research had not thoroughly examined the differences in performance and safety between the two approaches.
- An analysis of data from 3510 patients showed that RLLR had significant advantages over LLLR, including a lower rate of open conversions, reduced blood loss, and shorter operative times, even in patients with cirrhosis.
- Despite the improved perioperative outcomes for RLLR, postoperative metrics like readmission, morbidity, and mortality rates were similar between both surgical techniques.
Background: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes.
View Article and Find Full Text PDFBackground: Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies.
Methods: This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria.
Article Synopsis
- - The study investigates how body mass index (BMI) affects outcomes after laparoscopic left lateral sectionectomy (L-LLS), revealing that higher BMI levels (greater than 27kg/m²) lead to increased blood loss, longer operative times, and more open conversions during surgery.
- - A large sample of 2,183 patients from 59 centers worldwide was analyzed, showing that as BMI increases, so do certain negative surgical outcomes, but patient complications also exhibited a "U" shaped relationship—higher rates were seen in both underweight and obese individuals.
- - The findings suggest that BMI should be considered in evaluating the difficulty of L-LLS procedures and in future assessments of surgical risk and outcomes.
Article Synopsis
- The study aimed to compare outcomes of robotic major hepatectomy (R-MH) versus laparoscopic major hepatectomy (L-MH), exploring whether R-MH offers any advantages.
- An analysis of 4822 patient cases across 59 centers revealed that R-MH resulted in significantly less blood loss, fewer applications of the Pringle maneuver, and lower rates of conversion to open surgery.
- Moreover, R-MH showed reduced postoperative morbidity and shorter hospital stays for patients with cirrhosis compared to L-MH, indicating its potential benefits.
Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated.
Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria.
Objective: To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).
Background: There is limited published data to date on the best achievable outcomes after L-LR.
Methods: This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020.
Laparoscopic liver resection has been applied to treat most indications for liver resection during the past two decades. According to the literature, patient numbers have increased exponentially as a result, and surgical difficulty has increased as well. In expert centers, laparoscopic anatomical hemihepatectomy and major liver resection more than 3 segments have become the acceptable treatment.
View Article and Find Full Text PDFDonor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative recovery, laparoscopic liver graft harvest has been developed recently. However, to determine the cut point of bile duct is challenging.
View Article and Find Full Text PDFLaparoscopic hepatectomy and hepaticojejunostomy remain a surgical challenge despite the recent advances in minimally invasive surgery. A robotic surgical system has been developed to overcome the inherent limitations of the traditional laparoscopic approach. However, techniques of robotic hepatectomy have not been well described, and a description of robotic major hepatectomy with bilioenteric anastomosis can be found only in two previous reports.
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