Nexus Surgical Visitors

Tuesday, 17 June 2014

Neuroendocrine Tumours Lectures - Recent New Development and Advances in Diagnosis and Treatment By Dr Lisa Bodei (Itay) and Dr Irvin Modlin (USA) Chair: Dr Liau Kui Hin

Neuroendocrine Tumours Lectures
Recent New Development and Advances in Diagnosis and Treatment
By Dr Lisa Bodei (Itay) and Dr Irvin Modlin (USA)
Chair: Dr Liau Kui Hin 

Accurate Dosimetry for Peptide Receptor Radionuclide TherapyDr Lisa BodeiThe biologic basis for receptor radionuclide diagnosis and therapy is the receptor-mediated internalization and intracellular retention of a radiolabeled peptide.  An important factor in the success of this treatment and the avoidance of toxicity is delivery of the optimal dose in view of patient's body mass, tumor burdon and the absorbed dose in specific organs.

Multi-Transcript Analysis - A Better Marker for Neuroendocrine Tumors
Dr Irvin Modlin
There are no highly-specific biomarkers to detect neuroendocrine tumors.  Measurement of the neuroendocrine secretory peptide Chromogranin A (CgA) is used, but it is a single value, it is non-specific and the assay data are highly variable.  To better facilitate tumor detection, Dr Modlin's team developed a multi-transcript molecular signature for blood analysis, based on a large database of tissue samples from NET patients.  This molecular diagnostic process, now being marketed by Wren Labs as the 'NETest', is significantly more accurate than the CgA assay, is less vulnerable to false-positives, and shows promise as a screening test for early detection of neuroendocrine cancer.

Additional Presentation on Diagnostic Imaging
Dr Lisa Bodei

Thursday, 13 June 2013

Update on Pancreatic Neuroendocrine Tumours (PNET) Lecture by Dr Liau Kui Hin on 12 Oct 2013


DAY 1: SATURDAY, 12 OCTOBER 2013 (1600 - 1730)
Update on the Management of Pancreatic Neuroendocrine Tumours (PNET)
Dr Liau Kui Hin

Medical Director & Senior Consultant Surgeon,
Nexus Surgical Associates

Novel Approaches to the Management of Colorectal Liver Metastases
Dr Chan Chung Yip
Consultant, General Surgery
Singapore General Hospital, Singapore
Cholecystectomy: Minilaparoscopic Versus Single-Incision Laparoscopic (SILS) Cholecystectomy
Prof Gustavo Cavalo
Associate Professor of General Surgery
Pernambuco University, Brazil
Local Ablative Techniques for the Management of HCC
A/Prof Kenneth Mak
Chairman, Medical Board
Head and Senior Consultant
Department of General Surgery
Khoo Teck Puat Hospital, Singapore

Nexus Surgical Associates New Nurses

Welcome the following new nurses who join Nexus Surgical Associates this year.
1. Nurse Pak Xin Hui
2. Nurse Heather Ou Sok Feng
3. Nurse Nur Diana Binte Supomo
Happy to have these three nurses in the Nexus Surgical Family.

Wednesday, 12 June 2013

Revised Diagnostic Criteria and Severity Grading of Acute Cholangitis

 2013 Jan;20(1):24-34. 

TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos).



Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via

Revised Diagnostic Criteria and Severity Grading of Acute Cholecystitis

 2013 Jan;20(1):35-46.

TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos).



Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via

2013 Guidelines in the Management of Acute Cholangitis

 2013 Jan;20(1):60-70. 

TG13 antimicrobial therapy for acute cholangitis and cholecystitis.


Therapy with appropriate antimicrobial agents is an important component in the management of patients with acute cholangitis and/or acute cholecystitis. In the updated Tokyo Guidelines (TG13), we recommend antimicrobial agents that are suitable from a global perspective for management of these infections. These recommendations focus primarily on empirical therapy (presumptive therapy), provided before the infecting isolates are identified. Such therapy depends upon knowledge of both local microbial epidemiology and patient-specific factors that affect selection of appropriate agents. These patient-specific factors include prior contact with the health care system, and we separate community-acquired versus healthcare-associated infections because of the higher risk of resistance in the latter. Selection of agents for community-acquired infections is also recommended on the basis of severity (grades I-III). Free full-text articles and a mobile application of TG13 are available via

Publication on Adjuvant Hepatic Intra-arterial Iodine-131-Lipiodol

 2013 Jun;37(6):1356-61. 

Adjuvant Hepatic Intra-arterial Iodine-131-Lipiodol Following Curative Resection of Hepatocellular Carcinoma: A Prospective Randomized Trial.