10
THE STRAITS TIMES
JULY 18 2013
Screen early for liver disease
ASSOCIATE PROFESSOR
STEPHEN CHANG
ST ILLUSTRATION:
ADAM LEE
C
omment allez-vous?”, which
means “how are you?”, were the
first few French words that I
learnt while trying to survive in
France almost 10 years ago.
It can be fun to visit the
country as a tourist, but to live there for
a year with little knowledge of French is
very different.
I was there on a government-funded
programme to study laparoscopic
hepatectomy, which is liver surgery
done through keyholes, or small
incisions.
At that time, very few centres in the
world offered this minimally invasive
approach to liver surgery and a
particular centre in Paris had the most
experience then.
The enthusiasm to learn something
new and to bring the skill back to
Singapore motivated me to step out into
this foreign land.
When I returned to Singapore in 2005,
we officially started the keyhole liver surgery
programme at National University Hospital
(NUH).
The remarkable improvement to the speed of
recovery that I saw in my patients who underwent
liver surgery through this approach, compared with
the traditional open approach, was just the same
as that in my Caucasian patients in France.
I remember a patient in his 70s, who underwent
laparoscopic liver surgery.
The very next day after his surgery, I visited him
in the ward, expecting to see him lying on his bed.
Instead, he was sitting up on his bedside
armchair, with his legs crossed and one hand on
his phone as he spoke into it, informing his son of
his unbelievable well-being.
One of my junior doctors captured a candid
photo of him, which I have since used multiple
times to demonstrate the amazing recovery
experience after keyhole liver surgery in my talks to
surgeons around the world.
EARLY SCREENING OF PATIENTS VITAL
To date, NUH has performed more than 100 liver
operations via the keyhole approach.
Recently, we reviewed our own results
comparing the outcome of patients who underwent
the keyhole approach against that of patients who
were operated with the open approach. We
matched the extent of surgery, the degree of liver
disease and other demographic characteristics.
We found that not only do the patients who had
keyhole surgery recover better, but there is also
evidence to suggest that this sort of surgery
prolongs the period of time before any recurrence
of the disease, often liver cancer.
These results were similarly reported by other
centres around the world with
such expertise.
Unfortunately, a liver tumour has
to meet certain criteria for patients to
be eligible for this new approach.
Notably, the tumour should not be too
large.
For this criterion to be met, the tumour must be
detected early.
In Singapore, more than 80 per cent of liver
cancer arising from the liver itself is related to
hepatitis B, a viral infection of the liver.
The Ministry of Health, following international
guidelines and published evidence, recommends
that all patients with hepatitis B should have
six-monthly screening for early detection of
tumours.
Ms W was one such patient who had regular
follow-up visits with her liver specialist.
During one of these sessions, the ultrasound
examination picked up an early tumour.
She came to see me after hearing about the
keyhole approach to liver surgery.
As the tumour was small, she was found
suitable for it.
Her recovery was just as expected. Now, five
years have passed and she remains disease-free
and has been cured of that cancer.
PUSH FOR LIVER DISEASE AWARENESS
Early detection through regular follow-up and
screening is the key to curing liver cancer arising
from hepatitis B.
Unfortunately, the screening rate around the
world has been very low.
Many a time, doctors see patients coming with
the disease at a late stage, which inevitably
makes curing the disease difficult.
Many doctors chose the profession with the
hope of offering cures to patients.
When patients come to us and we can offer
none, we feel regret.
SUNDAY, JULY 28
Liver Disease Awareness Week – Public
Symposium
Learn about fatty liver disease and liver cancer,
whether they can be prevented and how they can
be treated.
College of Medicine Building, 16 College Road,
auditorium. 2 to 3.30pm (English), 4 to 6pm
(Mandarin). Free. No pre-registration needed. For
enquiries, call 6772-5300 or e-mail
[email protected].
The Hepatopancreatobiliary Association
(Singapore) was founded last year with the aim of
gathering experts in all specialities, such as
surgeons, internal medicine specialists and
researchers, who are interested in improving the
standard of care of patients with liver disease.
This year, the association is partnering the
Ministry of Health and the Hepatitis B Support
Group to organise the inaugural Liver Disease
Awareness Week.
The theme for this year’s campaign, which
starts on July 28, is Hepatitis B And Its Perils.
Through the week’s campaign, the association
hopes to raise awareness of the need for hepatitis
B screening and follow-up.
I managed to convince Ms W to share her
experience with us at a public symposium that will
launch the campaign.
She has yet to agree if she will bare her tummy
to show the inconspicuous scars of her surgery.
Perhaps, if I put my request to her in French, I
may have a better chance of charming her into
saying “oui”, or just yes.
[email protected]
Associate Professor Stephen Chang is a senior
consultant at the division of hepatobiliary and
pancreatic surgery at the National University
Hospital. He is also the chairman of the organising
committee for this year’s Liver Disease Awareness
Week and is the founding president of the
Hepatopancreatobiliary Association (Singapore).