Day surgery for thyroidectomy is uncommon in Hong Kong. Day hemithyroidectomy is rarely reported in the literature, whereas day total or completion thyroidectomy (TTCT) has not been discussed at all. To the best of our knowledge, this is the first report on the experience of TTCT. Using the computerized hospital system for operations performed, the details of patients who had been scheduled for TTCT between January 2015 and May 2018 were retrieved. Their hospital charts and operation records were retrospectively evaluated with respect to the indications of surgery, operation details, complications, conversion to inpatient admission and unplanned readmission. Forty-two eligible patients (25 total and 17 completion thyroidectomies) were identified. Total thyroidectomies were all done under general anaesthesia, whereas 70.6 per cent of completion thyroidectomies were done under local anaesthesia. The overall conversion rate to inpatient admission was 19 per cent. After total thyroidectomy, one patient was unexpectedly readmitted. No patient suffered from symptomatic hypocalcaemia, neck haematoma or mortality. There was no statistical difference between the two groups (total vs completion thyroidectomy) in terms of inpatient conversion following operation, unplanned readmission or surgical complications.
Necrotizing fasciitis is an uncommon yet potentially lethal condition that warrants prompt intervention. Its occurrence in the periorbital region is rare. Several unique anatomical features of the eyelids give rise to relatively lower mortality, yet its close proximity to the ocular apparatus poses special challenges in the management of the condition. In the current report, we present the first reported case of bilateral upper eyelids necrotizing fasciitis in Hong Kong, managed with early debridement and antibiotics coverage. The patient survived with preservation of vision.
Ureterocutaneous fistula is a major complication following renal transplantation. Timely management can minimise patient and graft comorbidities. We reported three cases of post‐renal transplant ureterocutaneous fistula. Two of them were successfully repaired with Boari flap and one of them were repaired with ileal interposition. Literature review revealed that double‐J stent insertion during renal transplant can significantly reduce post‐transplant major ureteric complications (MUC). Evidence did not show any difference in MUC between early removal of stent (≤14 days) and late removal (>14 days). Yet incidence of UTI could be reduced in early stent removal.
The incidence of chylothorax in our cohort was 9 per cent (14/155). There were nine biochemical chyle leaks (64.3 per cent) and five clinical leaks (35.7 per cent). The biochemical leakage group had a significantly higher 1-month morbidity rate compared to the nonchylothorax patients (89.9 vs 50 per cent, P =0.03). All biochemical leaks were resolved with conservative management. By routinely screening for chylothorax, the incidence was found to be 9 per cent, higher than that reported in the literature. The biochemical leak subgroup was found to have a higher 1-month morbidity rate. This could suggest that biochemical leakage of chyle might have a clinical impact on the recovery of postoesophagectomy patients.
Xanthogranulomatous cholecystitis (XGC) is a rare disease. The present study was conducted to evaluate the results of both open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), in patients with XGC. A retrospective study was performed including 4228 patients who underwent an OC or LC between January 2003 and November 2017. Sixty-three patients with XGC were identified, and their clinical and operative details were analysed. XGC is a rare disease associated with prolonged surgical times, high morbidity and a high LOC rate.
The present study involved a retrospective cohort of 604 patients at a local acute hospital in Hong Kong. Data were collected from the electronic health records for all first consultations at the surgical outpatient department for dyspepsia dating from 1 January to 31 December 2017. The MARK quadrant score was calculated and compared with upper gastrointestinal endoscopy findings and biopsy-proven pathologies. Subgroup analysis for independent risk factors was performed. Fifty biopsy-proven gastric neoplasms were identified, including 28 gastric adenocarcinomas, eight gastrointestinal stromal tumours, four gastric dysplasias and two gastric lymphomas. The area under the receiver-operating characteristic curve was 0.954 [95 per cent confidence interval (CI): 0.908-0.999, P <0.01]. At a cut-off of 10, sensitivity was 90 per cent and specificity was 98.2 per cent. For subgroup analysis, male sex and smoking were positively associated with gastric neoplasms, with an odds ratio of 2.46 (95 per cent: CI 1.37-4.41, P <0.01) and 2.60 (95 per cent CI: 1.36-4.98, P <0.01), respectively. The MARK quadrant score helps predict the likelihood of gastric neoplasms in dyspepsia. Male sex and smoking are independent risk factors of gastric neoplasms.
There are no established strategies for the surgical management of neuroendocrine liver metastases. Surgical treatment options include liver resection, liver transplantation and debulking hepatectomy. Other liver-directed therapies include local ablation and transarterial embolization. In the present review, we discuss the outcomes of the different surgical treatment modalities for neuroendocrine liver metastases. A review of the published literature on the surgical management of neuroendocrine liver metastases was undertaken. Liver resection is the curative treatment of choice for patients with grade 1 or 2 liver metastases without concurrent extra-hepatic disease. Liver transplantation is another potentially curative therapy. Debulking hepatectomy might be indicated for symptomatic neuroendocrine liver disease, whereas liver -directed local ablative and trans-arterial treatments should be considered for patients not suitable for liver resection or transplantation.
The new 2017 World Health Organization (WHO) classification of pancreatic neuroendocrine neoplasms (PanNEN) modifies the previous 2010 version with new grading and staging systems to provide a better prognostic stratification and therapeutic guidance. The discovery of heterogeneity in WHO 2010 G3 category leads to the introduction of the new ‘well‐differentiated neuroendocrine tumor G3’ entity, which is distinct from the poorly‐differentiated pancreatic neuroendocrine carcinoma (PanNEC). The latest findings from molecular studies of PanNEN allow us to have a better understanding of respective biology of PanNET and PanNEC. This review aims at highlighting refinements in the 2017 classification and discusses some of the molecular updates in PanNEN.
Pancreatic neuroendocrine tumours (pNET) are a group of heterogeneous tumours. Despite being rare, their incidence is rising. While localized lesions can be cured with surgical resection, most patients present with metastatic disease. Systemic therapy is thus integral for the management of this rare entity. Numerous advancements have been made in the past decade in the systemic treatment of unresectable, metastatic pNET. Treatment options for pNET include somatostatin analogues, cytotoxic chemotherapy, targeted agents and peptide receptor radionuclide therapy. In this Review, we present the latest evidence for these treatment options.