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Papers by Catherine Teh

Philippine Journal of Urology, 2019

This paper presents a case of a 53 year old, Filipino male, known to have Chronic Hepatitis B inf... more This paper presents a case of a 53 year old, Filipino male, known to have Chronic Hepatitis B infection, presenting with bloatedness and unintentional weight loss attributed to a 21.3cm x 18.2cm x 16.6cm right liver mass with radiographic features pathognomonic for Hepatocellular Carcinoma. An incidental finding of a right renal mass measuring 3.5cm x 3.2cm x 3.4cm is seen in the inferoposterior pole was noted. Multidisciplinary team collectively decided to proceed with outright surgical resection of both hepatic and renal masses over preoperative biopsies of the masses. Histopathologic report of the Right Hemihepatectomy and Right Partial Nephrectomy confirmed the occurrence of a Double Primary Malignancy of Hepatocellular Carcinoma Stage IB and Renal Cell Carcinoma Stage I. The postoperative course is unremarkable, and given a locoregional disease, the patient will undergo active surveillance for tumor recurrence. To the best of the authors' knowledge, this is the first case of double primary malignancy of the liver and kidney to be diagnosed and simultaneously resected in the Philippines. Improved prognosis of cancer patients and diagnostic modalities contributed to increasing number of reported cases with multiple primary malignancy. In the absence of a set standard of care, multidisciplinary approach has become of greater value in balancing the risks and benefits of selected timely interventions to the patients.

BJS, 2020

Background: The ongoing pandemic is having a collateral health effect on delivery of surgical car... more Background: The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods: This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results: Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion: Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.

HPB, 2019

The development of portal vein thrombosis (PVT) in cirrhotic patients awaiting liver transplantat... more The development of portal vein thrombosis (PVT) in cirrhotic patients awaiting liver transplantation is unclear. PVT not only aggravates liver function but also challenges liver transplantation techniques. We aimed to investigate possible predictive factors relating with PVT and the outcome after liver transplantation (LT). Method: From January 2013 to December 2015, a total of 349 cirrhotic patients who were awaiting liver transplantation were included. PVT is defined by radiologyrevealed filling defect in portal vein (PV) in all patients. Of the patients had liver transplantation, PV was confirmed with a PV thrombus during operation. We have assessed the correlation of the development of portal vein thrombosis (PVT, n=48) and the opposite group (non-PVT, n=301) with clinicopathologic features by Pearson's chisquared test. Univariate and multivariate analyses were carried out to identify independent risk factors, followed by survival analysis. Result: Forty-eight (13.8%) among all patients had PVT. The average MELD score was 16.4AE7.5. Presence of esophageal varices (EV), a positive EV bleeding history, INR prolongation, thrombocytopenia and relative deficiency of protein C and protein S level were observed for patients with PVT. Eighteen of forty-eight patients and 145 of 301 patients received liver transplantation in PVT and non-PVT group, respectively. Multivariate analysis demonstrated low protein S level (P= 0.017, HR= 2.46, 95% CI=1.17-5.46) as the only independent risk factor for PVT development. Protein S deficiency demonstrated prognostic value on short-term survival, not only for cirrhotic patient awaiting LT (1-year OS: 69.9 v.s 84.1%, p=0.012), but also for whom after LT (1-year OS: 70.4 v.s 84.8%, p=0.047). Conclusion: In cirrhotic patients awaiting LT, PVT development cause lots of clinical complexity and surgical challenges. Protein S deficiency not only correlates with PVT but also acts as an indicative prognostic factor independently. We suggest early LT for certain cases for a better Result.

HPB, 2019

Introduction: laparoscopic right posterior sectionectomy is a major challenge for laparoscopic li... more Introduction: laparoscopic right posterior sectionectomy is a major challenge for laparoscopic liver surgeons. The right posterior segment lays deep in the abdominal cavity; hence it is difficult to access during laparoscopic surgery. Methods: The patient was 61 years old man and diagnosed with 2 cm sized HCC on segment 7. During hepatectomy, We performed Pringle maneuver by laparoscopic Bulldog and used Cavitron Ultrasonic Surgical Aspirator(CUSA) for the parenchymal transection. We used THUNDER-BEATÔ (Olympus) for sealing, and division of Small hepatic vein branches and small glissonian pedicles, and iDriveTM Ultra Powered Stapling device (Medtronic) for major glissonian pedicle and large hepatic veins resections. At the end of the procedure, we placed the specimen in an endo-bag and extracted through Pfannenstiel incision. Results: we had no specific event during operation and no complication after surgery. The operation time was 250 min and the estimated blood lost less than 200 ml. On postoperative day 3, the computed tomographic scan showed no pathological findings. The patient was discharged on postoperative day 6 without complications. Conclusions: We argue that the laparoscopic posterior sectionectomy is safe and feasible for HCC.

HPB, 2018

Twelve patients underwent hepatectomy (minor in eleven; major in one); one peri-hepatic packing o... more Twelve patients underwent hepatectomy (minor in eleven; major in one); one peri-hepatic packing only. Five patients needed immediate surgery, four urgent and four delayed. Six patients underwent TAE. Postoperative morbidity according to Dindo-Clavien. Statistical analysis with SPSS v23.0 (significance with p< 0.05). Results: Median length of stay was 10 days (4-68). Major morbidity in three patients (23%); mortality in two cases (15%). Number of transfused units associated with increased risk of complications (p< 0.05). Five-year overall survival was 50%; 45% in HCC patients; 100% in HCA (p< 0.05).

Annals of clinical case reports, Nov 23, 2016

Post-operative histopathology 1. Right lobe: metastatic Colonic adenocarcinoma moderately differe... more Post-operative histopathology 1. Right lobe: metastatic Colonic adenocarcinoma moderately differentiated with mucinous features, resection margin negative for tumor.

Textbook of Pancreatic Cancer

HPB

operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusi... more operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusion: Hepatic artery pseudoaneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.

HPB

electrocautery alone. Among them, median time of hemostatic maneuver using saline-linked electoca... more electrocautery alone. Among them, median time of hemostatic maneuver using saline-linked electocautery alone was 27 second (range 10-95 second). There were two bleeding which was unable to control by SLiC-WOC method. Conclusion: For the bleeding which is difficult to control by electrocautery alone, saline-linked electrocautery combined with wet oxidized cellulose method is effective and time-efficient.

HPB

Introduction: Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy ... more Introduction: Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for Hepatocellular Carcinoma (HCC). Here, we aimed to identify the risk factors associated with SSI, and develop a novel nomogram to predict SSI among patients undergoing hepatectomy. Method: We retrospectively reviewed the data of 640 patients diagnosed with HCC undergoing hepatectomy at two academic institutions from April 2012 to March 2018, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analysis. Based on these independent risk factors, a nomogram was established using data of patients in the first institution and was validated in an external independent cohort from the second institution. Result: The nomogram was established using data from 309 patients while the validation cohort consisted of 331 patints. Duration of operation, hypoalbuminemia, repeat hepatectomy, bile leakage were identified as independent risk factors. The C-index of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a Cindex of 0.81. Accordingly, we stratified patients into 3 groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice. Conclusion: Our novel nomogram offers good preoperative prediction for SSIs in HCC patients undergoing hepatectomy.

JCO Global Oncology

PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained setting... more PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with...

Philippine Journal of Urology, 2019

This paper presents a case of a 53 year old, Filipino male, known to have Chronic Hepatitis B inf... more This paper presents a case of a 53 year old, Filipino male, known to have Chronic Hepatitis B infection, presenting with bloatedness and unintentional weight loss attributed to a 21.3cm x 18.2cm x 16.6cm right liver mass with radiographic features pathognomonic for Hepatocellular Carcinoma. An incidental finding of a right renal mass measuring 3.5cm x 3.2cm x 3.4cm is seen in the inferoposterior pole was noted. Multidisciplinary team collectively decided to proceed with outright surgical resection of both hepatic and renal masses over preoperative biopsies of the masses. Histopathologic report of the Right Hemihepatectomy and Right Partial Nephrectomy confirmed the occurrence of a Double Primary Malignancy of Hepatocellular Carcinoma Stage IB and Renal Cell Carcinoma Stage I. The postoperative course is unremarkable, and given a locoregional disease, the patient will undergo active surveillance for tumor recurrence. To the best of the authors' knowledge, this is the first case of double primary malignancy of the liver and kidney to be diagnosed and simultaneously resected in the Philippines. Improved prognosis of cancer patients and diagnostic modalities contributed to increasing number of reported cases with multiple primary malignancy. In the absence of a set standard of care, multidisciplinary approach has become of greater value in balancing the risks and benefits of selected timely interventions to the patients.

BJS, 2020

Background: The ongoing pandemic is having a collateral health effect on delivery of surgical car... more Background: The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods: This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results: Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion: Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.

HPB, 2019

The development of portal vein thrombosis (PVT) in cirrhotic patients awaiting liver transplantat... more The development of portal vein thrombosis (PVT) in cirrhotic patients awaiting liver transplantation is unclear. PVT not only aggravates liver function but also challenges liver transplantation techniques. We aimed to investigate possible predictive factors relating with PVT and the outcome after liver transplantation (LT). Method: From January 2013 to December 2015, a total of 349 cirrhotic patients who were awaiting liver transplantation were included. PVT is defined by radiologyrevealed filling defect in portal vein (PV) in all patients. Of the patients had liver transplantation, PV was confirmed with a PV thrombus during operation. We have assessed the correlation of the development of portal vein thrombosis (PVT, n=48) and the opposite group (non-PVT, n=301) with clinicopathologic features by Pearson's chisquared test. Univariate and multivariate analyses were carried out to identify independent risk factors, followed by survival analysis. Result: Forty-eight (13.8%) among all patients had PVT. The average MELD score was 16.4AE7.5. Presence of esophageal varices (EV), a positive EV bleeding history, INR prolongation, thrombocytopenia and relative deficiency of protein C and protein S level were observed for patients with PVT. Eighteen of forty-eight patients and 145 of 301 patients received liver transplantation in PVT and non-PVT group, respectively. Multivariate analysis demonstrated low protein S level (P= 0.017, HR= 2.46, 95% CI=1.17-5.46) as the only independent risk factor for PVT development. Protein S deficiency demonstrated prognostic value on short-term survival, not only for cirrhotic patient awaiting LT (1-year OS: 69.9 v.s 84.1%, p=0.012), but also for whom after LT (1-year OS: 70.4 v.s 84.8%, p=0.047). Conclusion: In cirrhotic patients awaiting LT, PVT development cause lots of clinical complexity and surgical challenges. Protein S deficiency not only correlates with PVT but also acts as an indicative prognostic factor independently. We suggest early LT for certain cases for a better Result.

HPB, 2019

Introduction: laparoscopic right posterior sectionectomy is a major challenge for laparoscopic li... more Introduction: laparoscopic right posterior sectionectomy is a major challenge for laparoscopic liver surgeons. The right posterior segment lays deep in the abdominal cavity; hence it is difficult to access during laparoscopic surgery. Methods: The patient was 61 years old man and diagnosed with 2 cm sized HCC on segment 7. During hepatectomy, We performed Pringle maneuver by laparoscopic Bulldog and used Cavitron Ultrasonic Surgical Aspirator(CUSA) for the parenchymal transection. We used THUNDER-BEATÔ (Olympus) for sealing, and division of Small hepatic vein branches and small glissonian pedicles, and iDriveTM Ultra Powered Stapling device (Medtronic) for major glissonian pedicle and large hepatic veins resections. At the end of the procedure, we placed the specimen in an endo-bag and extracted through Pfannenstiel incision. Results: we had no specific event during operation and no complication after surgery. The operation time was 250 min and the estimated blood lost less than 200 ml. On postoperative day 3, the computed tomographic scan showed no pathological findings. The patient was discharged on postoperative day 6 without complications. Conclusions: We argue that the laparoscopic posterior sectionectomy is safe and feasible for HCC.

HPB, 2018

Twelve patients underwent hepatectomy (minor in eleven; major in one); one peri-hepatic packing o... more Twelve patients underwent hepatectomy (minor in eleven; major in one); one peri-hepatic packing only. Five patients needed immediate surgery, four urgent and four delayed. Six patients underwent TAE. Postoperative morbidity according to Dindo-Clavien. Statistical analysis with SPSS v23.0 (significance with p< 0.05). Results: Median length of stay was 10 days (4-68). Major morbidity in three patients (23%); mortality in two cases (15%). Number of transfused units associated with increased risk of complications (p< 0.05). Five-year overall survival was 50%; 45% in HCC patients; 100% in HCA (p< 0.05).

Annals of clinical case reports, Nov 23, 2016

Post-operative histopathology 1. Right lobe: metastatic Colonic adenocarcinoma moderately differe... more Post-operative histopathology 1. Right lobe: metastatic Colonic adenocarcinoma moderately differentiated with mucinous features, resection margin negative for tumor.

Textbook of Pancreatic Cancer

HPB

operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusi... more operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusion: Hepatic artery pseudoaneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.

HPB

electrocautery alone. Among them, median time of hemostatic maneuver using saline-linked electoca... more electrocautery alone. Among them, median time of hemostatic maneuver using saline-linked electocautery alone was 27 second (range 10-95 second). There were two bleeding which was unable to control by SLiC-WOC method. Conclusion: For the bleeding which is difficult to control by electrocautery alone, saline-linked electrocautery combined with wet oxidized cellulose method is effective and time-efficient.

HPB

Introduction: Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy ... more Introduction: Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for Hepatocellular Carcinoma (HCC). Here, we aimed to identify the risk factors associated with SSI, and develop a novel nomogram to predict SSI among patients undergoing hepatectomy. Method: We retrospectively reviewed the data of 640 patients diagnosed with HCC undergoing hepatectomy at two academic institutions from April 2012 to March 2018, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analysis. Based on these independent risk factors, a nomogram was established using data of patients in the first institution and was validated in an external independent cohort from the second institution. Result: The nomogram was established using data from 309 patients while the validation cohort consisted of 331 patints. Duration of operation, hypoalbuminemia, repeat hepatectomy, bile leakage were identified as independent risk factors. The C-index of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a Cindex of 0.81. Accordingly, we stratified patients into 3 groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice. Conclusion: Our novel nomogram offers good preoperative prediction for SSIs in HCC patients undergoing hepatectomy.

JCO Global Oncology

PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained setting... more PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with...