K W Eu

Singapore General Hospital, Tumasik, Singapore

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Publications (133)425.82 Total impact

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    ABSTRACT: Objective: To identify methylated genes in serum with diagnostic potentials for early colorectal cancer (CRC). Methods: Serum methylation levels of up to 12 genes were measured in two sets of serum samples with the second set from 26 stage I CRC patients and 26 age/gender-matched controls. Results: Serum methylation levels of TAC1, SEPT9, and EYA4 were significant discriminants between stage I CRC and healthy controls. Combination of TAC1 and SEPT9 rendered 73.1% sensitivity with 92.3% specificity. Conclusion: Serum methylation levels of TAC1. SEPT9 and EYA4 may be useful biomarkers for early detection of CRC though a validation study is necessary.
    Biomarkers 08/2013; 18(5):399-405. DOI:10.3109/1354750X.2013.798745 · 2.26 Impact Factor
  • W S Tan · J F Lim · C L Tang · K W Eu ·
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    ABSTRACT: With improvements in surgical techniques, instrumentation and perioperative care, Hartmann's procedure is now less frequently performed. Restoration of intestinal continuity after Hartmann's procedure has traditionally been viewed to be technically demanding and associated with significant morbidity and mortality. This is a study of outcomes after the reversal of Hartmann's procedure in an Asian population. A prospectively collected database showed that 255 patients had undergone Hartmann's procedure from October 1989 to October 2005. Patients who subsequently underwent Hartmann's reversal were identified and their records reviewed retrospectively. Hartmann's reversal was attempted in 49 patients. The most common indication for Hartmann's procedure was colorectal carcinoma (49.0%). The median interval between resection and reversal was 23 weeks. Reversal was successful in 46 (93.9%) patients, with 79.6% experiencing no intraoperative complications. Failure of reversal was significantly associated with prior radiotherapy to the pelvis (p-value = 0.007). Anastomotic leak rates and re-bleeding rates were both 0.0%. 79.6% of patients made an uneventful recovery with no postoperative complications. There was no significant increase in the complication rate in older patients or patients with higher American Society of Anesthesiologists status. The overall incidence of 30-day morbidity and mortality was 20.4% and 0.0%, respectively. In our population, Hartmann's procedure is more commonly performed for colorectal cancer rather than for diverticular disease, resulting in lower rates of stoma reversal. Hartmann's reversal could be performed with acceptable morbidity and minimal mortality, although prior radiotherapy and shorter rectal stump may pose challenges during reversal surgery.
    Singapore medical journal 01/2012; 53(1):46-51. · 0.60 Impact Factor
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    ABSTRACT: With longer life expectancy, surgeons can expect to operate on older patients. Laparoscopic colorectal (LC) surgery has been demonstrated to be superior to open surgery. Controversy persists, however, regarding benefits of LC in the elderly due to increase in operative time. The aim of our study was to compare short-term outcomes of LC versus open colorectal (OC) surgery in elderly patients. Patients ≥70 years old that underwent elective LC between 2005 and 2008 were compared with controls who underwent OC. Data was extracted from a prospectively collected database. Seven hundred and twenty-seven patients underwent colorectal resection in this study period (LC n = 225, OC n = 502). The laparoscopic arm was characterised by shorter incisions (LC 6.0 cm vs. OC 12.0 cm, p < 0.001) but longer operating times (LC 125 min vs. OC 85 min, p < 0.001). Median use of narcotics and length of stay were significantly shorter in the laparoscopic group (LC 2 days vs. OC 3 days, p < 0.001 and LC 6 days vs. OC 7 days, p < 0.001, respectively). There was no significant difference in median recovery of bowel function (LC 4 days vs. OC 4 days, p = 0.14) and post-operative morbidity (p = 0.725). Thirty-day mortality was significantly lower in the laparoscopic arm (LC 1.3% vs. OC 4.6%, p = 0.03) This is the largest series from a single institution comparing LC and OC in elderly patients. In our series, LC in elderly patients was safe and not associated with a higher morbidity. LC was also associated with less narcotic use and shorter length of stay.
    International Journal of Colorectal Disease 12/2011; 27(6):773-80. DOI:10.1007/s00384-011-1375-5 · 2.45 Impact Factor
  • Eugene S A Yeo · Kheng Hong Ng · Kong Weng Eu ·

    Annals of the Academy of Medicine, Singapore 08/2011; 40(8):375-8. · 1.15 Impact Factor
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    M H Chew · H M Quah · K L Teh · T T C Loi · K W Eu · C L Tang ·
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    ABSTRACT: The Singapore Polyposis Registry (SPR) was established in 1989 at the Singapore General Hospital. This initiative was aimed at providing a central registry service to facilitate identification, surveillance and management of families and individuals at high risk of colorectal cancer. The aim of the present study was to provide a comprehensive review of all patients with familial adenomatous polyposis (FAP) syndrome in the SPR. All patients diagnosed with FAP in 1989-2009 were analysed. Data was extracted from a prospectively collected database. 122 patients from 88 families were analysed. The median age of this cohort was 29 (range 10-68) years. 97 percent of the cases were FAP and 3 percent were attenuated FAP. 92 patients tested positive for adenomatous polyposis coli gene. 42 percent of patients were diagnosed with colorectal cancer, of which 78 percent were diagnosed at an advanced stage. 73 percent of patients underwent restorative proctocolectomy and 21 percent had total colectomy. The median age at operation was 30 years. At median follow-up of 98 months, ten-year overall survival was 75.6 percent (95 percent confidence interval 67.0-84.2) and the median age at death was 40 years. For cancer cases, the overall recurrence was 13.5 percent. Recurrence and disease-free survival were not significant for the type of surgery performed (p-value is 0.486). The SPR plays an important and integral part in counselling patients and families with FAP. Improved surveillance programmes may be required to detect the development of cancers in these patients at an earlier stage.
    Singapore medical journal 04/2011; 52(4):246-51. · 0.60 Impact Factor
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    M T C Wong · J F Lim · K W Eu ·
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    ABSTRACT: Anal canal malignancies are rare tumours of the gastrointestinal tract that represent less than five percent of anorectal malignancies. We retrospectively reviewed patients with anal canal malignancies who were treated from April 1989 to December 2008. Patients were identified from a prospective database and records were analysed for age, gender, presenting symptoms, duration of symptoms, mode of diagnosis, histological subtypes, stage of disease, treatment received, duration of follow-up, recurrence rates and survival. A total of 61 patients were treated for anal canal malignancies, comprising 2.1 percent of all anorectal malignancies treated during the same period. There were 31 male and 30 female patients, with a median age at diagnosis of 61 (range 38-83) years. The commonest presenting symptoms were per rectal bleeding (69.4 percent) and pain (33.9 percent). The commonest histology was adenocarcinoma (50.8 percent) and squamous cell carcinoma (SCC) (40.3 percent). Patients underwent either surgery, radiotherapy, chemoradiation or a combination of modalities. The median duration of follow-up was 28 (range 1-120) months. Five patients developed recurrences after a median of 23 (range 2-36) months. The five-year overall survival and disease-free survival was 65.5 percent and 63.7 percent, respectively, with SCC showing a trend toward a better prognosis. Anal canal tumours are a rare clinical entity. They are usually present in the elderly with per rectal bleeding. They are usually treated using a multimodality approach, after the accurate establishment of histological diagnosis, which can yield reasonable survival rates.
    Singapore medical journal 01/2011; 52(1):9-14. · 0.60 Impact Factor
  • Eugene S A Yeo · Ming Hian Kam · Kong Weng Eu ·

    Annals of the Academy of Medicine, Singapore 10/2010; 39(10):806-8. · 1.15 Impact Factor
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    Yon Kuei Lim · Kheng Hong Ng · Kong Weng Eu ·
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    ABSTRACT: We present the first 7 cases of single site right hemicolectomy in Asia using the new Single Site Laparoscopy (SSL) access system from Ethicon Endo-surgery. Right hemicolectomy was performed using the new Single Site Laparoscopy (SSL) access system. Patient demographics, operative time, histology and post operative recovery and complications were collected and analysed. The median operative time was 90 mins (range 60 - 150 mins) and a median wound size of 2.5 cm (range 2 to 4.5 cm). The median number of lymph nodes harvested was 24 (range 20 to 34 lymph nodes). The median length of proximal margin was 70 mm (range 30 to 145 mm) and that of distal margin was 50 mm (35 to 120 mm). All patients had a median hospital stay of 7 days (range 5 to 11) and there were no significant perioperative complications except for 1 patient who had a minor myocardial event. Right hemicolectomy using SSL access system is feasible and safe for oncologic surgery.
    World Journal of Surgical Oncology 09/2010; 8(1):79. DOI:10.1186/1477-7819-8-79 · 1.41 Impact Factor
  • M T C Wong · K H Ng · K S Ho · K W Eu ·
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    ABSTRACT: Published data has confirmed the oncological safety and efficacy of laparoscopic colorectal surgery. Continued surgical innovation has seen the recent resurgence of single-port laparoscopic surgery. We present a series of 10 cases of single-incision laparoscopic surgery (SILS) for right hemicolectomy, with the aim of reaffirming the feasibility and favourable short-term results of this technique. Ten patients underwent SILS for right hemicolectomy using the SILS port, between June 2009 and August 2009. A longitudinal periumbilical incision was used as the access point for all cases. Data analysed included age, gender, American Society of Anaesthesiology score, body mass index (BMI), location of disease, duration of surgery, length of incision and duration of hospital stay. Inclusion criteria were no prior abdominal surgery, no intra-abdominal sepsis, no distant metastases and a BMI of <30. All 10 cases of right hemicolectomy were successfully performed using the SILS port through a single periumbilical incision. The median age of patients was 64 years (range 48-83 years), with a median body mass index of 21.5 kg/m(2) (range 18.9-25.6 kg/m(2)). The median duration of surgery and hospital stay was 83 min (range 60-125 min) and 6 days (range 5-11 days), respectively. No morbidity or mortality was associated with this technique, and all patients recovered uneventfully. This case series illustrates that SILS for right hemicolectomy is feasible and safe. However, the routine use of this innovative technique in malignant disease cannot be recommended without further large-scale prospective trials.
    Techniques in Coloproctology 09/2010; 14(3):225-8. DOI:10.1007/s10151-010-0596-x · 2.04 Impact Factor
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    M.T.C. Wong · K H Ng · J F Lim · B S Ooi · C L Tang · K W Eu ·
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    ABSTRACT: Evidence from randomised controlled trials has shown that laparoscopic colon and rectal cancer resection not only confers short-term benefits but also does not differ considerably in terms of its long-term oncological outcomes, as compared with open surgery. All laparoscopic colon and rectal resections performed between January 2005 and December 2007 were included. Patient records were reviewed from a prospective database and the relevant clinical data was obtained, with a subgroup analysis of cancer procedures performed. 418 patients (247 male), median age 63 years (range 24 to 88), underwent laparoscopic resection of the colon and rectum. The median Body Mass Index (BMI) was 22.5 (range 13.5 to 39.3). The majority of the procedures were performed for malignant disease (81.3 percent) and the most common procedure was anterior resection (79.4 percent). The median duration of surgery was 135 minutes (range 65 to 330), with conversions to open surgery in 44 patients (10.5 percent). Complications occurred in 78 patients (18.7 percent), including anastomotic leaks in five (1.20 percent). The median length of hospital stay was five days (range 3 to 90) and the median follow-up was 19 months (range 1 to 46). In the 340 patients with malignant disease, the median number of lymph nodes harvested was 13 (range 5 to 48), and at the latest review, 230 patients (67.6 percent) were disease-free, with locoregional recurrence in 2.9 percent and systemic recurrence in 10 percent. To date, this is the largest series of laparoscopic colorectal resections reported locally, and our results show that it is safe, feasible and produces favourable results.
    Singapore medical journal 08/2010; 51(8):650-4. · 0.60 Impact Factor
  • S A Yeo · M H Chew · K W Eu ·

    British Journal of Surgery 08/2010; 97(8):1311; author reply 1311-2. DOI:10.1002/bjs.7209 · 5.54 Impact Factor
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    M T C Wong · J.F. Lim · K.S. Ho · B.S. Ooi · C.L. Tang · K.W. Eu ·
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    ABSTRACT: Pelvic radiotherapy is an essential component of potentially curative therapy for many pelvic malignancies; however, the rectum consequently often sustains collateral injury. The researchers retrieved patient data that was prospectively gathered over a ten-year period between January 1995 and December 2004. The relevant details, including gender, age, pelvic pathology for which radiotherapy was administered, the presenting symptoms, the interval between radiotherapy and the onset of symptoms, the mode of diagnosis, treatments received, length of hospital stay and duration of follow-up, were analysed. During the period under review, 77 patients were admitted for the treatment of radiation proctitis, with a median follow-up period of 14 (range 1-61) months. There were 23 male and 54 female patients, with a median age of 63.9 (range 37-89) years. The most common underlying cancers were gynaecological (63.6 percent), prostate (18.2 percent) and colorectal (15.6 percent) cancer. The most common presenting symptom was bleeding per rectum (89.6 percent), with a change in bowel habits a distant second (10.4 percent). The median latent period between the completion of radiotherapy and the onset of symptoms was 24 (range 3-68) months. The majority of the patients (72.5 percent) received non-surgical treatment, most commonly using topical 4 percent formalin solution to arrest the bleeding, with more than half the patients requiring repeat treatments. 14 (18.2 percent) patients required colorectal resections for intractable bleeding, intestinal obstruction or intra-abdominal sepsis. Radiation proctitis can be a therapeutic challenge, even in the most experienced hands. The majority of patients who present with per rectal bleeding can be treated using topical modalities, while surgery may offer the only chance of relief from life-threatening symptoms.
    Singapore medical journal 04/2010; 51(4):315-9. · 0.60 Impact Factor
  • Yi Hong · Thomas Downey · Kong Weng Eu · Poh Koon Koh · Peh Yean Cheah ·
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    ABSTRACT: Metastasis is the major cause of cancer mortality. We aimed to find a metastasis-prone signature for early stage mismatch-repair proficient sporadic colorectal cancer (CRC) patients for better prognosis and informed use of adjuvant chemotherapy. The genome-wide expression profiles of 82 age-, ethnicity- and tissue-matched patients and healthy controls were analyzed using the Affymetrix U133 Plus 2 array. Metastasis-negative patients have 5 years or more of follow-up. A 10 x 10 two-level nested cross-validation design was used with several families of classification models to identify the optimal predictor for metastasis. The best classification model yielded a 54 gene-set (74 probe sets) with an estimated prediction accuracy of 71%. The specificity, sensitivity, negative and positive predictive values of the signature are 0.88, 0.58, 0.84 and 0.65, respectively, indicating that the gene-set can improve prognosis for early stage sporadic CRC patients. These 54 genes, including node molecules YWHAB, MAP3K5, LMNA, APP, GNAQ, F3, NFATC2, and TGM2, integrate multiple bio-functions in various compartments into an intricate molecular network, suggesting that cell-wide perturbations are involved in metastasis transformation. Further, querying the ;Connectivity Map' with a subset (70%) of these genes shows that Gly-His-Lys and securinine could reverse the differential expressions of these genes significantly, suggesting that they have combinatorial therapeutic effect on the metastasis-prone patients. These two perturbagens promote wound-healing, extracellular matrix remodeling and macrophage activation thus highlighting the importance of these pathways in metastasis suppression for early-stage CRC.
    Clinical and Experimental Metastasis 02/2010; 27(2):83-90. DOI:10.1007/s10585-010-9305-4 · 3.49 Impact Factor
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    Eng Shi Ong · Li Zou · Shaoxia Li · Peh Yean Cheah · Kong Weng Eu · Choon Nam Ong ·
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    ABSTRACT: Colorectal cancer (CRC) arises as the consequence of progressive changes from normal epithelial cells through polyp to tumor, and thus is an useful model for studying metabolic shift. In the present study, we studied the metabolomic profiles using high analyte specific gas chromatography/mass spectrometry (GC/MS) and liquid chromatography tandem mass spectrometry (LC/MS/MS) to attain a systems-level view of the shift in metabolism in cells progressing along the path to CRC. Colonic tissues including tumor, polyps and adjacent matched normal mucosa from 26 patients with sporadic CRC from freshly isolated resections were used for this study. The metabolic profiles were obtained using GC/MS and LC/MS/MS. Our data suggest there was a distinct profile change of a wide range of metabolites from mucosa to tumor tissues. Various amino acids and lipids in the polyps and tumors were elevated, suggesting higher energy needs for increased cellular proliferation. In contrast, significant depletion of glucose and inositol in polyps revealed that glycolysis may be critical in early tumorigenesis. In addition, the accumulation of hypoxanthine and xanthine, and the decrease of uric acid concentration, suggest that the purine biosynthesis pathway could have been substituted by the salvage pathway in CRC. Further, there was a step-wise reduction of deoxycholic acid concentration from mucosa to tumors. It appears that to gain a growth advantage, cancer cells may adopt alternate metabolic pathways in tumorigenesis and this flexibility allows them to adapt and thrive in harsh environment.
    Molecular &amp Cellular Proteomics 02/2010; DOI:10.1074/mcp.M900551-MCP200 · 6.56 Impact Factor
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    ABSTRACT: Peutz-Jeghers Syndrome (PJS) is an uncommon autosomal dominant hamartomatous polyposis syndrome. Morbidity arises from polyp-related complications and increased risks of malignancy. We report on PJS patients registered in the Singapore Polyposis Registry, identified principal causes of morbidity and appraised current management strategies. A followup protocol based on recent literature has been proposed. A search of a prospectively collected database in the Singapore Polyposis Registry was made. Only patients who fulfilled the diagnostic criteria of PJS were included. The clinical records were retrieved for review. Information on affected family members was obtained from the Registry's pedigree records. Seven unrelated patients fulfilled the criteria of having PJS. Principal causes of morbidity include recurrent bouts of abdominal colic, episodes of intestinal obstruction, gastrointestinal bleeding and the need for repeated laparotomies. Six out of 7 patients had initial presentation with acute intestinal obstruction requiring emergency laparotomy. Management was mostly problem-oriented and marked inter-surgeon variation with regard to cancer screening and genetic counselling was observed. Patients with PJS suffer gastrointestinal complications from polyposis and are at increased risks for developing cancers. A move towards surveillance and planned comprehensive care may reduce the morbidity of the condition. A protocol driven approach conducted in the setting of a Polyposis Registry is ideally suited to facilitate such care.
    Annals of the Academy of Medicine, Singapore 01/2010; 39(1):17-21. · 1.15 Impact Factor
  • Ming Hian Kam · Jit Fong Lim · Kok Sun Ho · Boon Swee Ooi · Kong Weng Eu ·
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    ABSTRACT: BackgroundStapled haemorrhoidectomy has been performed with different techniques and staplers. We review our initial experience with the new DST EEA 33 stapler and neu@ anoscope. MethodsA review of all patients who underwent stapled haemorrhoidectomy using the DST EEA 33 over a 14-month period was conducted. Short-term outcomes of bleeding, pain and retention of urine requiring admission or strictures requiring surgical intervention were studied. ResultsThere were 1,118 patients operated from August 2007 to October 2008. The median age was 46-year-old (20–82years) and 51% were females. The median operating time was 15min (range 5–45min), and median follow-up was 7months (range 3–16months). There were 26 patients (2.3%) who were admitted for inability to pass urine and 20 required catheterisation. Fifty-two patients (4.6%) were admitted for post-operative bleeding. In 32 cases the bleeding stopped spontaneously, while 19 patients required adrenaline injection and packing for hemostasis. Only one patient required surgical hemostasis. Thirty-three patients (2.9%) were admitted for post-operative pain and stayed for a median of 1day (range 1–4days). There were 14 patients (1.2%) who developed anorectal strictures requiring surgical intervention. All underwent anoplasty at a median of 3months post-operatively (range 2–5months), with good result. There were no recurrent haemorrhoids during follow-up. ConclusionStapled haemorrhoidectomy using the DST EEA 33 stapler is safe. The neu@ anoscope provides good visibility and handling, and is a useful tool in this procedure.
    Techniques in Coloproctology 12/2009; 13(4):273-277. DOI:10.1007/s10151-009-0532-0 · 2.04 Impact Factor
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    ABSTRACT: Deletion of 11q23-q24 is frequent in a diverse variety of malignancies, including breast and colorectal carcinoma, implicating the presence of a tumor suppressor gene at that chromosomal region. We examined a 6-Mb region on 11q23 by high-resolution deletion mapping, using both loss of heterozygosity analysis and customized microarray comparative genomic hybridization. LARG (leukemia-associated Rho guanine-nucleotide exchange factor) (also called ARHGEF12), identified from the analysed region, is frequently underexpressed in breast and colorectal carcinomas with a reduced expression observed in all breast cancer cell lines (n=11), in 12 of 38 (32%) primary breast cancers, 5 of 10 (50%) colorectal cell lines and in 20 of 37 (54%) primary colorectal cancers. Underexpression of the LARG transcript was significantly associated with genomic loss (P=0.00334). Hypermethylation of the LARG promoter was not detected in either breast or colorectal cancer, and treatment of four breast and four colorectal cancer cell lines with 5-aza-2'-deoxycytidine and/or trichostatin A did not result in a reactivation of LARG. Enforced expression of LARG in breast and colorectal cancer cells by stable transfection resulted in reduced cell proliferation and colony formation, as well as in a markedly slower cell migration rate in colorectal cancer cells, providing functional evidence for LARG as a candidate tumor suppressor gene.
    Oncogene 10/2009; 28(47):4189-200. DOI:10.1038/onc.2009.266 · 8.46 Impact Factor
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    W P Fu · H M Quah · K W Eu ·
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    ABSTRACT: Necrotising fasciitis is a life-threatening soft tissue infection that is associated with high mortality and morbidity. It has been described in the form of Fournier's gangrene following rectal perforations related to colorectal cancer. In these rare instances, spontaneous perforation of locally-advanced rectal carcinoma provides an entry point for bacterial seeding to the surrounding soft tissues, resulting in Gram-negative sepsis of the perineum. To our knowledge, necrotising fasciitis extending beyond the perineum due to rectal perforation has not been previously described. We report an unusual self-induced traumatic rectal perforation presenting with severe necrotising fasciitis of the lower limb in a 73-year-old Chinese man. Our patient was successfully treated with a multidisciplinary approach that involved a defunctioning colostomy as well as prompt and rigorous debridement of the affected limb. We also review the literature on the management of retroperitoneal rectal perforations and their sequela, as well as discuss the various surgical options commonly applied and their outcomes.
    Singapore medical journal 09/2009; 50(8):e270-3. · 0.60 Impact Factor
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    K H Ng · YK Lim · K S Ho · B S Ooi · K W Eu ·
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    ABSTRACT: The use of robotics in colorectal surgery is relatively new. The first few cases of colonic surgery using da Vinci Surgical System were reported in 2002. Since then, several centres had reported on their experience, with favourable outcomes. Our department started to embark on robotics in colorectal surgery in December 2007. The aim of our paper was to share our early experience with robotics in colorectal surgery and provide an update on the current status of robotics. Preparations included formal training with the da Vinci Surgical System, certification of the surgeons, and obtaining Hospital Ethics committee approval. We used a hybrid technique of laparoscopic and robotic assistance in the resection of mid- to low-rectal cancer (total mesorectal excision). Laparoscopic approach was used to isolate the inferior mesenteric artery and for mobilisation of the left colon. The da Vinci robot was used in the dissection of the rectum down to the pelvic floor. We reviewed the outcomes of our early experience with emphasis on feasibility and safety. Over a period of three months, we performed eight cases of robotic-assisted colorectal surgery for cancer. The median age of the patients was 55 (range 42-80) years. The median operating time was 192.5 (range 145-250) minutes. There were no intraoperative or postoperative complications related to the use of robotics. The median length of hospital stay was five (range 4-30) days. Robotic-assisted laparoscopic colorectal surgery is a safe and feasible procedure.
    Singapore medical journal 09/2009; 50(8):763-7. · 0.60 Impact Factor
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    ABSTRACT: Hereditary mixed polyposis syndrome (HMPS) is characterized by polyps of mixed adenomatous/hyperplastic/atypical juvenile histology that are autosomal dominantly inherited and that eventually lead to colorectal cancer (CRC). Although CRC with adenomatous polyps is initiated by inactivating adenomatous polyposis coli (APC), the initiating event of CRC with mixed polyps remains unclear. We aimed to identify the underlying germline defect in HMPS. We screened for bone morphogenesis protein receptor 1A (BMPR1A) mutation by exonic sequencing, reverse-transcriptase polymerase chain reaction (PCR) followed by cDNA sequencing, and multiplex ligation-dependent probe amplification (MLPA) analysis in eight Singapore Chinese HMPS families. Germline BMPR1A defects were found in four (50%) families. In two families, it is shown to co-segregate with the disease phenotype in all affected members over three generations, indicating that it is the disease-causing mutation. CRC incidence is 75%. The most defining characteristic is the presence of mixed hyperplastic-adenomatous polyps. Juvenile polyps are rarely reported, and if present, are usually of mixed components. Detailed histology of the polyps from one patient over 11 years distinguishes HMPS from juvenile polyposis syndrome (JPS). We report further the first cases of Wilms' tumor and papillary thyroid carcinoma associated with BMPR1A germline defect. Germline BMPR1A defect is the disease-causing mutation in 50% of the HMPS families. If patients present with mixed morphology polyps in the large bowel that are autosomal dominantly inherited and corresponding absence of upper gastrointestinal abnormalities, the gene to begin mutation screening should be BMPR1A rather than APC.
    The American Journal of Gastroenterology 09/2009; 104(12):3027-33. DOI:10.1038/ajg.2009.542 · 10.76 Impact Factor

Publication Stats

4k Citations
425.82 Total Impact Points


  • 1993-2013
    • Singapore General Hospital
      • • Department of Colorectal Surgery
      • • Department of General Surgery
      Tumasik, Singapore
  • 2005
    • Changi General Hospital
      • Department of General Surgery
      Tumasik, Singapore