William I Wei

Queen Mary Hospital, Hong Kong, Hong Kong

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Publications (85)249.87 Total impact

  • Velda L.Y. Chow, Jimmy Y.W. Chan, William I. Wei
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    ABSTRACT: BACKGROUND Management of cervical oesophageal tumour post-oesophagectomy is mainly palliative due to inadequate exposure of tumour in the cervicothoracic region. In this study we propose a means of cure for these patients.METHODS Between January 2003 and June 2013, six patients underwent curative pharyngo-laryngectomy and completion cervical oesophagectomy via manubrial resection. Operative outcomes were analyzed and compared with a historical cohort who received palliative therapy.RESULTSOne patient required prolonged hospital-stay for pneumonia, resulting in a median hospital-stay of 30 (21-55) days. All resumed oral feeding at a mean of 15.2 (14-19) days. Tracheostoma stenosis was noted in two. One developed nodal recurrence, another with distant metastasis, resulting in a median disease-free survival of 13 (4-20) months. Median overall survival was significantly longer than the cohort group (19.0 vs 3.0 mths, p=0.013).CONCLUSIONS Salvage surgery in patients with carcinoma of the cervical oesophagus post-oesophagectomy is feasible with significantly prolonged survival. Head Neck, 2014
    Head & Neck 05/2014; · 2.83 Impact Factor
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    ABSTRACT: Background. Minimally invasive nasopharyngectomy with the da Vinci surgical robot has been shown to be a feasible operation for salvage of recurrent nasopharyngeal carcinoma. The current case series presents the early results of robotic nasopharyngectomy. Method. A prospective series of patients who underwent robotic nasopharyngectomy for recurrent nasopharyngeal carcinoma in a single institution. Results. 12 patients underwent robotic nasopharyngectomy. The median operating time was 225 minutes. Median follow up time was 23.8 months. 9 patients had clear resection margins. 2 patients had close margins and 1 patient had positive margin. 2 patients developed local recurrence and 1 patient had distant metastasis. Two patients in the cohort died of unrelated cause. The 2-year local control rate was 86%. The 2-year overall survival and disease free survival was 83% and 61% respectively. Conclusions. Early results of robotic nasopharyngectomy showed a high local control rate. The operating time was comparable to open surgery and morbidities were low. Head Neck, 2014.
    Head & Neck 03/2014; · 2.83 Impact Factor
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    ABSTRACT: Objective: To validate a follow-up protocol based on the long-term outcomes and recurrence rates in patients who have undergone surgical treatment for olfactory neuroblastoma. Methods: A prospective review of all patients treated for olfactory neuroblastoma at our institution over a 35-year period. Results: Ninety-five patients were treated from 1978-2013, with craniofacial (65 patients) or endoscopic resection (30 patients). Duration of follow-up ranged from 1-309 months (mean 88.66 months). Fifty-six patients were alive and well and 13 were alive with recurrent disease. Twenty-one patients had died of disease and three had died of intercurrent disease. Overall survival was 83.4% at 5 years and 76.1% at 10 years. Disease free survival at 5 years was 80% and at 10 years was 62.8%. A Cox regression analysis showed orbital extension and intracranial involvement to be significant independent factors affecting outcome. Local and regional recurrence occurred after an average of 49 months but with a range of 3 - 233 months. Conclusion: In our series, olfactory neuroblastoma most commonly recurred within the first 4 years but can recur very late, after 19.4 years in one case. There is currently no universally accepted follow-up regime, but even late recurrence is eminently treatable. We therefore propose a protocol for lifelong follow-up with both clinical examination and serial imaging, including the neck and entire intracranial compartment.
    The Laryngoscope 12/2013; · 1.98 Impact Factor
  • The Laryngoscope 04/2013; · 1.98 Impact Factor
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    ABSTRACT: PURPOSE: Radiotherapy has been the mainstay treatment for nasopharyngeal carcinoma (NPC) and has achieved good disease control. However, irradiation is associated with potential complications such as osteoradionecrosis (ORN) and infection. There is sparse description in the literature of such complications and how they are best managed. The objectives of the study are: (1) to describe the complications at the cervical spine after surgical and radiotherapy treatment for NPC (2) to identify key principles in the diagnosis and treatment of these complications. METHODS: A retrospective review of all patients with cervical spine complications after radiation treatment and surgery for NPC treated in a tertiary referral center, since 1990. RESULTS: Fourteen patients with cervical spine ORN and infections were found with an average duration to diagnosis of 8.6 years. All 14 patients had mucosal and deep biopsies and none had tumor recurrence. Four patients had ORN, eight had osteomyelitis and two patients had both ORN and osteomyelitis. CONCLUSIONS: Radiotherapy complications usually have delayed and subtle presentations. ORN progresses slowly and can often be treated conservatively. Infections should be treated aggressively with surgical debridement and the results are generally good. Patients should be regularly followed-up with transoral examination to assess the integrity of the posterior pharyngeal wall and imaging to assess for ORN. Pharyngeal defects raise concern for cervical spine infections. Coverage of pharyngeal defects in these patients is important to prevent recurrent infection.
    European Spine Journal 12/2012; · 2.47 Impact Factor
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    ABSTRACT: Objective: To assess the long-term audiological outcome and otological complications of nasopharyngeal carcinoma patients who have received intensity-modulated radiotherapy (IMRT) versus conventional two-dimensional radiotherapy (2 DRT). Study Design: Prospective study on the audiological outcome and otological complications 5-9 years after radiotherapy. Methodology: Patients had pure-tone audiogram before radiotherapy and 5 years after radiotherapy. Otological examination was performed 5-9 years after radiotherapy by an otolaryngologist. Results: There is a significant deterioration of the hearing threshold 5 years after radiotherapy but there is no statistically significant difference in the deterioration of hearing between IMRT and 2 DRT. Six patients in the 2 DRT group and 1 patient in the IMRT group had osteoradionecrosis of the external auditory canal (p = 0.042). Conclusion: There are fewer incidences of osteoradionecrosis of the external auditory canal in patients treated with IMRT. There is no difference in bone conduction threshold in patients treated with IMRT or 2 DRT.
    ORL 08/2012; 74(4):228-33. · 1.10 Impact Factor
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    ABSTRACT: Introduction Impact of treatment and prognostic indicators of outcome are relatively ill-defined in esthesioneuroblastomas (ENB) because of the rarity of these tumors. This study was undertaken to assess the impact of craniofacial resection (CFR) on outcome of ENB. Patients and Methods Data on 151 patients who underwent CFR for ENB were collected from 17 institutions that participated in an international collaborative study. Patient, tumor, treatment, and outcome data were collected by questionnaires and variables were analyzed for prognostic impact on overall, disease-specific and recurrence-free survival. The majority of tumors were staged Kadish stage C (116 or 77%). Overall, 90 patients (60%) had received treatment before CFR, radiation therapy in 51 (34%), and chemotherapy in 23 (15%). The margins of surgical resection were reported positive in 23 (15%) patients. Adjuvant postoperative radiation therapy was used in 51 (34%) and chemotherapy in 9 (6%) patients. Results Treatment-related complications were reported in 49 (32%) patients. With a median follow-up of 56 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 78, 83, and 64%, respectively. Intracranial extension of the disease and positive surgical margins were independent predictors of worse overall, disease-specific, and recurrence-free survival on multivariate analysis. Conclusion This collaborative study of patients treated at various institutions across the world demonstrates the efficacy of CFR for ENB. Intracranial extension of disease and complete surgical excision were independent prognostic predictors of outcome.
    Journal of neurological surgery. Part B, Skull base. 06/2012; 73(3):208-20.
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    ABSTRACT: Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as a means of coming to a definitive diagnosis. Benign tumours and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.
    ISRN otolaryngology. 01/2012; 2012:872982.
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    ABSTRACT: The purpose of this study was to present the outcome of nasopharyngectomy for locally advanced recurrent nasopharyngeal carcinoma (NPC). Between 2000 and 2010, patients with locally advanced recurrent NPC were recruited. Surgical outcomes were analyzed retrospectively. Among the 22 patients recruited, all had extended resections via the maxillary swing approach, resulting in exposure of the petrosal part of the internal carotid artery (ICA). One patient required craniofacial approach for tumor removal. The curative resection rate was 81.8%. Free flap reconstruction was performed in all cases. The mean follow-up period was 38.8 months. All patients survived. Although 1 patient developed local and systemic tumor recurrence, the rest of the patients remained disease free. There was no carotid blowout or osteoradionecrosis of the skull base. Curative resections can be achieved for locally advanced recurrent NPC with good outcome. Microvascular free flap reconstruction is crucial to prevent carotid artery blowout and osteoradionecrosis of the skull base.
    Head & Neck 08/2011; 34(7):923-8. · 2.83 Impact Factor
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    ABSTRACT: Nasopharyngeal carcinoma (NPC) is a distinctly radiosensitive and chemosensitive tumor. Best quality radiotherapy is demanded to build up the complex concave high-dose zone for this critical location. Intensity-modulated (IMRT) technique is advocated, image guidance to ensure setup precision and adaptive re-planning if major deviations from intended dose distribution occur during the treatment course are useful improvements if resources allow. Stringent dose constraint to organs at risk should be attempted to minimize late toxicities. Addition of cisplatin-based concurrent-adjuvant chemotherapy is recommended for patients with stages III–IVB and high-risk stage IIB diseases. More contemporary series using IMRT together with extensive use of chemotherapy and acceleration reported very encouraging early results with locoregional control in excess of 90% at 2–4 years; the key remaining problem is distant failure. Further improvement of efficacy by changing chemotherapy sequence to induction-concurrent is being explored.The plasma level of Epstein–Barr Viral Deoxyribonucleic Acid is an additional tool for nonkeratinizing carcinoma for prognostication and monitoring disease progress. Integrated fluorodeoxyglucose positron emission tomography and computed tomography is useful for excluding distant metastases and posttreatment persistent/recurrent disease. Early detection of failure is critical for increasing the chance of salvage; aggressive treatment should be attempted as far as possible, long survival can be achieved for patients with limited failure or metastasis. Different salvage methods and reported results are summarized. KeywordsNasopharyngeal carcinoma-Radiotherapy-Concurrent chemotherapy-Salvage treatment-Late toxicity
    06/2011: pages 381-400;
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    ABSTRACT: We report a case of resecting a recurrent nasopharyngeal carcinoma using a combined technique of transoral robotic surgery and transnasal endoscopic surgery. A small recurrent tumor was located in the roof of the nasopharynx. The inferior part of the resection was performed with a da Vinci surgical robot transorally after splitting the soft palate to expose the nasopharynx. The superior part of the resection, including removal of the anterior wall and floor of the sphenoid was performed transnasally under endoscopic vision. The tumor was removed enbloc with the sphenoid sinus wall with clear resection margin. Recovery was uneventful and the patient had minimal morbidity from the operation. For minimally invasive surgery to resect recurrent nasopharyngeal carcinoma, transnasal endoscopic surgery and transoral robotic surgery compliments each other, allowing improved resection.
    Head & Neck 03/2011; 34(8):1190-3. · 2.83 Impact Factor
  • William I Wei, Dora L W Kwong
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    ABSTRACT: The primary treatment modality of nasopharyngeal carcinoma (NPC) is radiation or chemoradiation. With the application of conformal radiation and appropriate chemotherapeutic agents, there was marked improvement in the outcome. Despite this, a small number of patients still develop residual or recurrent disease either in the neck or at the primary site. In recent years there are many developments in the disciplines of surgery, radiation and medical oncology which are applicable for the management of residual or recurrent NPC. It is timely to review the applicability and efficacy of the various therapeutic options. The theme of the literature review included the management of these recurrent or residual diseases in the neck or nasopharynx with open or endoscopic or robot-assisted surgical approaches. The application of radiation techniques such as intensity modulated radiotherapy, stereotactic radiation and brachytherapy was also included. The use of chemotherapy and targeted agents is also reviewed. In general, the size, extent and location of the residual or recurrent NPC together with the biological behaviour of the tumour determine the optimal therapy. The surgical and clinical oncological expertise applied optimally will give the best outcome.
    Current opinion in otolaryngology & head and neck surgery 03/2011; 19(2):82-6.
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    ABSTRACT: Pharyngo-laryngo-esophagectomy (PLE) has been regarded as a standard treatment for cervical esophageal cancer, but the morbidity and mortality rates associated with PLE are substantial. Chemoradiation (CTRT) is widely used to treat esophageal cancer; however, its role in managing cervical esophageal cancer has not been fully elucidated. It was hypothesized that up-front CTRT could be an effective alternative treatment option to PLE. The purpose of this study was to compare the outcomes of patients with cervical esophageal cancer treated with these two methods. Patients with cervical esophageal cancer from 1995 to 2008 were studied. Three main groups were identified: those treated with PLE, those managed with up-front concurrent chemoradiation, and those not suitable for either PLE or chemoradiation but to whom palliative treatment was offered. The demographics, management strategies, and outcomes of these patients were studied and analyzed. A total of 107 patients were studied: 87 (81.3%) were men, and the median age was 64 years (range 17-92 years). There were 62 patients who underwent PLE as the primary treatment, 21 had up-front chemoradiation, and the others had palliative treatment. In the PLE group, curative resection was achieved in 37 (59.7%) patients, 20 of whom had either adjuvant chemoradiation or radiotherapy. The hospital mortality rate was 7.1%. In the chemoradiation group, 10 (47.6%) had tumor down-staging, 6 of whom achieved a clinically complete response. Among the 11 patients with poor response, 5 required salvage PLE for palliation. Chemoradiation-associated morbidities included oral mucositis, bilateral vocal cord palsy, esophageal stricture, carotid artery blowout, and permanent hypothyroidism and hypoparathyroidism. The median survival durations of patients in the PLE and chemoradiation groups were 20 and 25 months respectively (P = 0.39). Up-front chemoradiation can be an alternative therapeutic strategy to PLE. However, this method is not without drawbacks. A significant proportion also requires salvage surgery. Both PLE and chemoradiation have significant curative as well as palliative role in the management of cervical esophageal cancer and treatment should be individualized.
    World Journal of Surgery 03/2011; 35(3):600-7. · 2.23 Impact Factor
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    ABSTRACT: The purpose of this study was to report on our experience on salvage nasopharyngectomy using the maxillary swing approach for persistent or recurrent nasopharyngeal carcinoma after primary treatment. Over the past 2 decades, we have performed salvage nasopharyngectomies for 246 patients. Thirty-seven patients (15%) had persistent disease and 209 (85%) had recurrent tumors. All patients survived the operation with minimal morbidity. Negative resection margins were achieved in 191 patients (78%), and 55 patients (22%) had microscopic residual disease. The median follow-up was 38 months. The 5-year actuarial control of disease in the nasopharynx was 74%. The 5-year disease-free survival was 56%. Cox regression model identified the negative resection margin and the size of the tumor as 2 independent factors that affected local control of disease and survival. Maxillary swing nasopharyngectomy is an effective salvage procedure for a small, persistent, or recurrent tumor in the nasopharynx after primary therapy.
    Head & Neck 10/2010; 33(7):969-75. · 2.83 Impact Factor
  • William I Wei, Wai-Kuen Ho
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    ABSTRACT: Transoral robotic nasopharyngectomy was carried out for a patient who developed recurrent nasopharyngeal cancer after radiotherapy. The tumor in the left lateral wall of the nasopharynx was exposed after splitting the soft palate and a curative resection, including the medial crus of the eustachian tube was carried out under the three-dimensional 0° camera. The operative procedure was uncomplicated, blood loss was minimal and the patient recovered smoothly. The camera of the surgical robot provided superb visualization of the operative field and the maneuverability of the robotic arms with the Endowrist design allowed adequate tumor extirpation. The morbidity associated with the procedure was minimal, and this surgical procedure can be applied for resection of small and favorably located residual or recurrent nasopharyngeal cancer or other appropriate pathologies in the region. Laryngoscope, 2010.
    The Laryngoscope 10/2010; 120(10):2011-4. · 1.98 Impact Factor
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    William I Wei, Dora L W Kwong
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    ABSTRACT: Nasopharyngeal carcinoma is an unique head and neck cancer. It is common among the southern Chinese and is closely associated with the Epstein Barr virus (EBV). To diagnose the disease in its early stage is infrequent as the symptoms are usually trivial and patients only present in late stages. Testing the blood for elevated EBV DNA has now become a screening test for the high risk group of patients, aiming to diagnose the disease in its early stages. Imaging studies, positron emission tomography scans in addition to clinical examination provide information on the extent of the disease. The confirmation of the disease still depends on endoscopic examination and biopsy. Radiotherapy with or without chemotherapy has been the primary treatment modality. The application of intensity modulated radiotherapy and the use of concomitant chemoradiation have improved the control of nasopharyngeal carcinoma together with the reduction of long term side effects. The early detection of residual or recurrence tumor in the neck or at the primary site has allowed delivery of salvage treatment. The choice of the optimal surgical salvage, either for neck disease or primary tumor depends on the extent of the residual or recurrent disease. The outcome of these patients have improved with the application of the appropriate surgical salvage.
    Clinical and Experimental Otorhinolaryngology 03/2010; 3(1):1-12. · 0.88 Impact Factor
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    ABSTRACT: There is controversy about the efficacy of treating patients with laryngopharyngeal reflux (LPR) using proton pump inhibitors (PPIs). We assessed the effects of high doses of the PPI rabeprazole in patients with LPR. Patients with LPR symptoms were assigned randomly to receive rabeprazole (20 mg, twice daily, n = 42) or placebo (n = 40) for 12 weeks. All patients completed symptom questionnaires; these provided demographic information and the reflux symptom index before, during, and 6 weeks after cessation of treatment. Videolaryngostroboscopy was used to document the laryngeal findings and determine the reflux finding score. Twenty-four patients (57.1%) in the rabeprazole group and 27 patients (67.5%) in the placebo group had pH-documented LPR. The total reflux symptom index score decreased significantly in the group given rabeprazole, compared with patients given placebo, at weeks 6 and 12, but not at week 18. However, there were no significant differences in reflux finding scores between the rabeprazole and placebo groups at any of the time points. Twelve weeks of treatment with rabeprazole (20 mg, twice daily) significantly improved reflux symptoms, compared with placebo, in patients with LPR. Relapse of symptoms was observed 6 weeks after stopping PPI therapy, indicating the requirement for longer treatment duration in patients with LPR.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2010; 8(9):770-6. · 5.64 Impact Factor
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    ABSTRACT: The study aimed to assess the outcome of live-donor liver transplantation for pediatric patients in a region with limited access to deceased donors. From September 1993 to September 2008, 78 pediatric patients aged between 73 days and 17 years (mean, 40 months) received 83 liver transplants. Sixty-two were living-related liver transplantations (LRLTs), and 21 were deceased-donor liver transplantations (DDLTs). The mean follow-up period was 6.5 years. The prospectively collected data of these patients were analyzed retrospectively. The 1-, 2-, and 5-year survival rates of patients and grafts were 91%, 90%, 88% and 87%, 86%, 83%, respectively. The survival rates of LRLT patients and DDLT patients were 89%, 89%, 87%, and 90%, 86%, 86%, respectively (P = .58). The survival rates of patients aged 12 months or younger and patients older than 12 months were 95%, 92%, 90% and 90%, 90%, 87%, respectively (P = .65). One live donor developed temporary peroneal palsy, and another developed lung collapse (3%, 2/62). All live donors resumed their normal activities with no difficulty. With meticulous surgical techniques and postoperative care, it is justifiable to accept donated livers from voluntary live donors for transplantation to save pediatric patients in a place with scarce deceased donors.
    Journal of Pediatric Surgery 12/2009; 44(12):2316-21. · 1.38 Impact Factor
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    ABSTRACT: The aim of the study was to characterize the distribution of anterior skull base (ASB) cancers in the pediatric population and to identify predictors of outcome. This was an international study of 1307 patients undergoing craniofacial surgery for malignant tumors; 6.4% (n = 84) among these were <or=21 years old. The most common histologic type was sarcoma (40%), followed by squamous cell carcinoma (14%). Higher incidence of tumors was found in older children (7.5-21 years) compared to younger children. The 5-year disease-specific and overall survival rates were 61% and 55%, respectively (median follow-up of 30 months). The best prognosis was associated with low-grade sarcomas and the worst with salivary and squamous cell carcinomas. High-grade sarcoma represented an intermediate risk group. On multivariate analysis, prior radiotherapy and histology were independent predictors of survival. Surgery for malignant tumors involving the ASB is feasible and safe in children. Histology is significant determinant of poor outcome in this population.
    Head & Neck 12/2008; 31(3):308-17. · 2.83 Impact Factor
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    ABSTRACT: We analyzed a single center's experience over a decade of right liver living donor liver transplantation (RLDLT). To define the donor risk and recipient benefit ratio, midterm outcome of this life-saving treatment modality ought to be known. Consecutive patients from 9 May 1996 were included. Era I comprised the first 50 patients and Era II comprised the remaining 184 patients. Their midterm outcomes were compared with patients receiving deceased donor liver transplantation (DDLT) of the same period in the same center. With a median follow-up of 48 months, the 1-, 3-, and 5-year overall survival rates were 93.2%, 85.7%, and 82.4%, respectively and were comparable with those of DDLT (n = 131) (90.1%, 87.7%, and 85.2%) (P = 0.876). Hospital mortality decreased from 16% in Era I to 2.2% in Era II (P = 0.000). Reduced hospital mortality improved the overall survival rates from Era I to Era II (78%, 74%, and 72% vs. 97.3%, 88.7%, and 85.1%, respectively) (P = 0.003). The 5-year survival rate of recipients with hepatocellular carcinoma (HCC) (n = 65) was 65.7%. Starting from Era II, excellent 5-year survival of recipients without HCC was achieved as compared with DDLT in the same period (93.4% vs. 88.2%) (P = 0.493). The 5-year survival rates of recipients with HCC within the Milan criteria of Era II and DDLT in the same period were 72.0% and 100%, respectively (P = 0.091). Multivariate analysis indicated that only Era I (relative risk = 2.606; P = 0.005) and pretransplant HCC (relative risk = 2.729; P = 0.002) adversely affected overall survival. High midterm survivals were achieved by reduction of hospital mortality through accumulation of experience and transplanting recipients with low chance of recurrence of HCC. RLDLT could be considered as a legitimate alternative to DDLT.
    Annals of surgery 10/2008; 248(3):411-9. · 7.90 Impact Factor

Publication Stats

1k Citations
249.87 Total Impact Points

Institutions

  • 1999–2014
    • Queen Mary Hospital
      Hong Kong, Hong Kong
  • 2013
    • Hong Kong Sanatorium & Hospital
      Hong Kong, Hong Kong
  • 2003–2012
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Head and Neck Service
      New York City, NY, United States
    • University of Pittsburgh
      • Department of Surgery
      Pittsburgh, PA, United States
  • 1988–2012
    • The University of Hong Kong
      • • Department of Surgery
      • • Department of Clinical Oncology
      Hong Kong, Hong Kong
  • 2007
    • UCL Eastman Dental Institute
      Londinium, England, United Kingdom
  • 2003–2007
    • University of Udine
      • Department of Medical and Biological Sciences
      Udine, Friuli Venezia Giulia, Italy
  • 2005
    • Griffith University
      • School of Medicine
      Brisbane, Queensland, Australia
  • 2004
    • University of London
      Londinium, England, United Kingdom