William I Wei

Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong

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Publications (133)361.54 Total impact

  • Raymond King-Yin Tsang · William I. Wei

    No preview · Chapter · Jan 2016
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    Raymond King-Yin Tsang · William I. Wei
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    ABSTRACT: Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC. Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC. Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment. Traditional form of retreatment was to employ a second course of radiation. The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal. Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications.
    Full-text · Article · Oct 2015
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    Valerie J. Lund · William I. Wei
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    ABSTRACT: Introduction: Curative resection of malignant tumours of the skull base is increasingly undertaken endoscopically. Hitherto the diverse histology, rarity and long natural history have made it difficult to accrue statistically robust cohorts for comparison with conventional craniofacial resection. It is now possible to make such a comparison in a large personal cohort. Method: Data on all cases of sinonasal malignancy undergoing endoscopic resection with curative intent over an eighteen year period were collected prospectively and analysed for survival and prognostic factors. Results: There were 140 cases, 68 men and 72 women, aged 20-92 years (mean 63 yrs). Follow-up ranged from 6-184 months (mean 60 months). Eighteen different histopathologies were represented with olfactory neuroblastoma (36), malignant melanoma (33) and adenocarcinoma (19) being the commonest. Additional radiotherapy was given in 95 cases and chemotherapy in 49. Overall survival is 84% at 5 years and 69% at 10 years. Overall disease-free survival was 77% at 5 years and 56% at ten. Overall and disease-free survival at 5 (and 10) years is, respectively, 97% and 90% for olfactory neuroblastoma, 79% and 68% for adenocarcinoma and 56% and 39% for malignant melanoma. Conclusion: These results show that endoscopic resection is an alternative to conventional craniofacial resection in selected cases.
    Full-text · Article · Sep 2015 · Rhinology
  • Raymond King-Yin Tsang · William I Wei
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    ABSTRACT: While primary radiotherapy is the treatment of choice for treatment naïve nasopharyngeal carcinoma (NPC), surgery plays an important role in salvaging recurrent diseases. Due to the anatomical location of the nasopharynx, many approaches have been proposed by various authors in the last 30 years to resect locally recurrent tumors in the nasopharynx. There are advantages and disadvantages of various approaches. Of all the approaches, the anterolateral approach with the maxillary swing operation has the largest published experience of over 300 cases from multiple centres. The approach provides wide exposure with minimal postoperative morbidities. Technological advances in the last decade enabled surgeons to resect small recurrent tumors in the nasopharynx with an endoscopic approach or robotic approach, further reducing the morbidities. With the relatively short follow up time of these minimally invasive approaches, the long term oncological outcome could not be compare to open approaches at this stage. Nodal recurrences in NPC is now are after the introduction of concurrent chemoradiation. Nodal recurrence can still be salvaged with a standard radical neck dissection. More extensive disease with invasion to soft tissue of the neck can be salvaged with extended neck dissection together with after-loading brachytherapy as second radiation and reconstruction of the surgical defect with flaps. With advanced imaging technologies, small isolated metastasis to the liver and lung can be detected early. Early experience in resection of these isolated metastasis to the liver and lung showed survival benefits in this group of advanced stage NPC patients. Larger scale studies would be needed to define the role of surgical resection in managing NPC patients with isolated metastasis.
    No preview · Article · Jun 2015 · Minerva otorinolaringologica
  • 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
    No preview · Article · Jul 2014 · Head & Neck
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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.
    No preview · Article · Jul 2014 · The Laryngoscope
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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. Methods: We conducted a prospective series of patients who underwent robotic nasopharyngectomy for recurrent nasopharyngeal carcinoma in a single institution. Results: Twelve patients underwent robotic nasopharyngectomy. The median operating time was 225 minutes. Median follow-up time was 23.8 months. Nine patients had clear resection margins, 2 patients had close margins, and 1 patient had positive margin. Two patients developed local recurrence and 1 patient had distant metastasis. Two patients in the cohort died of unrelated causes. The 2-year local control rate was 86%. The 2-year overall survival and disease-free survival was 83% and 61%, respectively. Conclusion: Early results of robotic nasopharyngectomy showed a high local control rate. The operating time was comparable to open surgery and morbidities were low.
    Full-text · Article · Mar 2014 · Head & Neck

  • No preview · Article · Sep 2013 · The Laryngoscope
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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.
    No preview · Article · Dec 2012 · European Spine Journal
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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.
    No preview · Article · Aug 2012 · ORL
  • Raymond King Yin Tsang · Wai Kuen Ho · William I Wei
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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.
    No preview · Article · Aug 2012 · Head & Neck
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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.
    No preview · Article · Jul 2012 · Head & Neck
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    ABSTRACT: Melanomas account for 4% of sinonasal malignancies. We present the largest single institution series reported thus far and analyze the outcome with reference to lymph node involvement, radiotherapy and endoscopic resection. Survival and recurrence data were analyzed on sinonasal melanoma cases collected from 1963-2010 to compare treatment strategies and to ascertain factors predicting outcome. 115 cases (mean age 65.9) were treated at our institution during this period. All underwent surgical resection of the tumour, 31 (27%) endoscopically, and 51 (44%) also received radiotherapy. Five year overall survival was 28% and disease-free survival was 23.7%. Local control was achieved for a median of 21 months, 5-year disease control rate of 27.7%. Endoscopically resected cases showed a significant overall survival advantage up to 5 years. Radiotherapy did not improve local control or survival. Cervical metastases conferred a dramatically worse outcome. Endoscopic resection of sinonasal melanoma does not prejudice outcome. The role of radiotherapy is unproven.
    No preview · Article · Jun 2012 · Rhinology
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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.
    Full-text · Article · Jun 2012 · Journal of Neurological Surgery, Part B: Skull Base
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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.
    Full-text · Article · Feb 2012
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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.
    Full-text · Article · Jul 2011 · Head & Neck
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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
    No preview · Chapter · Jun 2011
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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.
    Full-text · Article · Mar 2011 · World Journal of Surgery
  • 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.
    No preview · Article · Mar 2011 · Current opinion in otolaryngology & head and neck surgery
  • 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.
    No preview · Article · Oct 2010 · The Laryngoscope

Publication Stats

4k Citations
361.54 Total Impact Points

Institutions

  • 2014-2015
    • Hong Kong Sanatorium & Hospital
      Hong Kong, Hong Kong
  • 1984-2014
    • Queen Mary Hospital
      Hong Kong, Hong Kong
  • 1988-2012
    • The University of Hong Kong
      • Department of Surgery
      Hong Kong, Hong Kong
  • 2003
    • University of Pittsburgh
      • Department of Surgery
      Pittsburgh, PA, United States
  • 2001-2002
    • The Hong Kong University of Science and Technology
      Chiu-lung, Kowloon City, Hong Kong