Making the impossible possible
Liver Transplant and Surgery Team
Queen Mary Hospital
In Hong Kong, approximately 60% to 70% of patients are diagnosed with liver cancer at an intermediate to advanced stage. Many of these patients also suffer from chronic conditions such as cirrhosis, significantly reducing their chances of receiving resection surgery to remove the tumours. As a result, improving surgical feasibility and patient survival rates has become the primary motivation for the Liver Transplant and Surgery Team in their pursuit of innovative technologies and treatments.
The Team introduced ‘Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy' (ALPPS) in 2013; in 2019, they launched the world-first ‘Sequential TransArterial chemobolisation and stereotactic RadioTherapy Followed by ImmunoTherapy' (START-FIT) strategy, saving over 150 lives so far. ALPPS involves first partitioning the liver to enable rapid hypertrophy of the healthy portion, and then removing the tumour-bearing section. This approach offers new hope for patients whose tumours were previously deemed unresectable due to insufficient future liver remnant volume.
Later, when the COVID-19 epidemic broke out in 2019, public hospitals faced a shortage of beds. To avoid delaying patients' treatment, the START-FIT strategy was born, an innovation ‘driven' by the challenging environment as described by the Team, "most of the START-FIT treatment procedures can be completed in an ambulatory setting, which not only enhances the flexibility and safety of treatment, but also frees up valuable hospital beds for fighting the epidemic."
The first patient who underwent the START-FIT had a tumour measuring 20cm. His family simply hoped to take him on a trip to help him relax during his final days. Nevertheless, encouraged by the Team, he opted for this innovative strategy and the outcome was remarkable – his tumour shrank to 4cm and his lung metastases disappeared. "Seeing the patient recover and travel with his family in good health, enjoying quality time together, is undoubtedly the greatest encouragement for our Team." START-FIT has been included in the National Guidelines for the Management of Liver Cancer in China (2024 and 2026 Editions), gaining national recognition for its effectiveness.
Moving forward, the Team plans to introduce robotic technology for liver transplant surgeries and a ‘organ perfusion system' designed to extend the storage time and maintain the quality of donated cadaveric livers. However, the Team emphasises that public support for organ donation is essential for giving more patients the opportunities for a renewed life.
