Department of Surgery, CUHK
INTRANET EVENTS NEWS


INTRODUCTION

Surgery Team 3 is the Division of Colorectal Surgery of the Department of Surgery at The Chinese University of Hong Kong (CUHK). Based at Prince of Wales Hospital, the teaching hospital of CUHK, the Division provides a comprehensive colorectal service as well as acute general surgical service to patients from within the New Territories East Cluster region. It is also a tertiary referral centre for some of the most complex and challenging clinical cases, including large colorectal polyps, advanced and recurrent colorectal cancer, complex inflammatory bowel disease, complicated proctological conditions, and functional colorectal disorders. The Division is one of the highest volume colorectal units in Hong Kong, performing about 300 major colorectal resections and 4,500 colonoscopies each year. Led by Dr Janet Lee (Hospital Authority) and Prof Simon Ng (CUHK), the Division is also world-renowned for its education and research in the field of colorectal surgery and surgical oncology.

TEAM VISION

To position CUHK as a world-leading centre in cutting-edge research and innovation, as well as a centre of excellence in colorectal surgery and training.

SERVICES

Colorectal Cancer Care
The Division of Colorectal Surgery provides a comprehensive range of services for patients with colorectal cancer, from diagnosis through treatment and recovery. We partner with a multidisciplinary team (MDT) of specialists including Medical Oncologists, Radiation Oncologists, Radiologists, Pathologists, and Colorectal Nurses to deliver a highly efficient, personalised, and patient-centred care. All patients with advanced colorectal cancer will have their cases discussed and their treatment planned at our regular MDT meetings. The use of multimodal treatment consisting of preoperative chemoradiotherapy, consolidation chemotherapy, and minimally invasive surgery (including robotic and transanal surgery, and intersphincteric resection), has resulted in better oncological outcomes and higher sphincter preservation rate in patients with distal rectal cancer. We also offer ultramajor or extended resections such as pelvic exenteration, multivisceral resection, and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) to patients with more advanced or recurrent diseases with a view to improving their chance of survival and quality of life.

Minimally Invasive Surgery
We offer a whole range of minimally invasive surgery for benign and malignant colorectal disease:

  • Laparoscopic colorectal surgery (multiport and single port)
  • Robotic colorectal surgery (multiport and single port)
  • Transanal minimally invasive surgery and transanal endoscopic operation
  • Transanal total mesorectal excision
All the above procedures are complementary to our current practice of enhanced recovery or fast-track programme.

Advanced Endoscopy
We provide conventional and advanced diagnostic and therapeutic colonoscopy services, such as endoscopic mucosal resection, endoscopic submucosal dissection (ESD), and colonic stenting. Our Division performs about 100 colorectal ESDs each year, which is the highest volume unit in Hong Kong.

Inflammatory Bowel Disease (IBD)
We are one of the tertiary referral centres for complex IBD in Hong Kong. As a key member of the multidisciplinary IBD team at Prince of Wales Hospital, we offer joint clinic review with Gastroenterologists, specialist in-patient consultations, as well as surgery to patients refractory to medical treatment and to those who developed complications.

Proctology
Our Division offers a wide range of diagnostic to therapeutic services for patients with anorectal disease:

  • Endorectal ultrasound scan
  • Haemorrhoidal surgery, including Doppler-guided haemorrhoidal artery ligation
  • Fistula-in-ano surgery, including advancement flap, ligation of intersphincteric fistula tract (LIFT) procedure, collagen paste injection, and laser therapy
  • Fissure-in-ano surgery, including Botox injection and advancement flap

Functional Colorectal Disorder
Our Division is a tertiary referral centre for patients with complex functional colorectal disorders, such as faecal incontinence, obstructive defaecation, and low anterior resection syndrome. We offer a comprehensive multidisciplinary service including:

  • Endoanal ultrasound scan
  • High resolution anorectal manometry
  • Dynamic imaging (defaecating proctogram)
  • Biofeedback
  • Behavioural therapy
  • Irrigation training

EDUCATION

The Division of Colorectal Surgery plays an integral role in medical education for undergraduate (Medicine Year 4 and 6) and postgraduate (taught and research programmes) students. Prof Simon Ng has received multiple teaching awards for undergraduate education over the years. Besides teaching, our Division is also involved in research and development of innovative pedagogy, and we have received a number of teaching grants for the development of web-based teaching platforms to enhance learning of our medical students.

As an accredited training centre, the Division provides basic and higher training to our surgical trainees in General Surgery. Our Division is also one of the seven recognised training centres in Colorectal Surgery subspecialty training in Hong Kong. We offer short-term Clinical Observership and 1-year Advanced Fellowship to international surgeons who would like to gain expertise in advanced minimally invasive and robotic surgery. Our Division is also actively organising educational workshops and conferences to disseminate new knowledge and transfer advanced skills to the surgical community worldwide.

RESEARCH

Minimally invasive surgery has always been the main clinical and research focus of the Division. Over the years, we have published several landmark randomised controlled trials that support and standardise the practice of laparoscopic surgery for colorectal cancer worldwide. Funded by research grants, our current clinical trials aim to further improve the outcomes of laparoscopic colorectal surgery. These include the application of prehabilitation and fast-track programme, cologeriatric care, and electroacupuncture.

Our Division offers the most advanced techniques and technologies, including robotic surgery, transanal surgery, and endoluminal resection in treating colorectal neoplasms. We are dedicated to provide high-quality scientific evidence to clarify the role of these technological innovations in clinical practice. Recently, we completed the world's first clinical trial of robotic colorectal surgery using the latest da Vinci SP Surgical System.

Functional colorectal disease is another research focus of our Division, for which we are currently evaluating two innovative diagnostic systems - the EndoFLIP and Fecobionics. Moreover, we are investigating the use of transcutaneous electric nerve stimulation on acu-points in patients with defaecatory disorders.

In collaboration with the Institute of Digestive Disease, CUHK, we are conducting clinical research related to population-based colorectal cancer screening, as well as translational research in diagnostic and prognostic biomarker discovery for colorectal cancer. Other basic and translational research interests of the Division include circulating tumour cells, patient-derived colorectal cancer organoids, checkpoint inhibitors and natural killer cell-based immunotherapy for colorectal cancer, probiotics for colorectal cancer prevention, and adipose-derived mesenchymal stem cell therapy for anastomotic healing.

Ongoing Clinical Research Projects

  1. A new opportunity for subtyping dyssynergia constipation patients (GRF 14112020*)
  2. Suppressed fecal evacuation as an induction mechanism of chronic constipation (HMRF 07180856*)
  3. Pathophysiological signatures of chronic constipation using Fecobionics device (GRF 14106717*)
  4. The effect of metacognition-based, manualized intervention on fear of cancer recurrence: a randomized controlled trial (GRF 17616619)
  5. A randomized study of neoadjuvant chemoradiotherapy with or without intensification with the FOLFOXIRI chemo-regimen for high-risk locally advanced rectal cancer (HMRF 06170426)
  6. Transanal total mesorectal excision versus robotic total mesorectal excision for mid and low rectal cancer: a prospective randomized controlled trial (HMRF 06171156*)
  7. Electroacupuncture combined with fast-track perioperative program for reducing duration of postoperative ileus and hospital stay after laparoscopic colorectal surgery: a randomized controlled trial (HMRF 15162641*)
  8. Endoscopic submucosal dissection (ESD) versus transanal minimally invasive surgery (TAMIS) for early rectal neoplasms: a prospective randomized controlled trial (HMRF 04153006*)
  9. Impact of screen size on colorectal adenoma detection rate: a single centre randomized controlled trial (CUHK Direct Grant 2019.098*)
  10. Prospective, single arm study to assess the safety and performance of the EndoMaster EASE System for the treatment of colorectal lesions
  11. Outcome of elective cancer surgery during the COVID-19 pandemic crisis: an international, multicenter, observational cohort study (CovidSurg-Cancer)

Ongoing Basic/Translational Research Projects

  1. The diagnostic significance of CDH17-positive circulating tumor cells and therapeutic implication of targeting CDH17 protein in colorectal cancer (GRF 15106619)
  2. Prevention of colorectal cancer by probiotics (Lim Peng Suan Charitable Trust Research Grant*)
  3. Gut microbiota across early stages of synucleinopathy: from high-risk relatives, REM sleep behavior disorder to early Parkinson's disease (HMRF 05162876)
  4. 細胞分泌因數VSTM2A在結直腸癌中的功能研究及其作為結直腸癌分子診斷標誌物的應用價值 (國家自然科學基金*)
  5. Immune checkpoints in colorectal cancer
  6. Patient derived preclinical models for translational cancer research
  7. Beneficial efficacy of combined therapy using turmeric and chemotherapeutics in colorectal cancer – a final proof prior to clinical trial
  8. Model establishment for metastasis prediction and identification of preventive herbal medicine in colorectal cancer using patient-derived xenografts

* Member of the Division of Colorectal Surgery as the PI of the research grant

ACHIEVEMENTS
  • Pioneered laparoscopic colorectal surgery in Hong Kong and Asia
  • Published the world's first randomised controlled trial comparing laparoscopic and open resection of rectosigmoid carcinoma
  • Published the world's first pooled analysis of long-term oncological outcomes (>10 years) from our three randomised controlled trials comparing laparoscopic open surgery for rectal cancer
  • Performed the first robotic colorectal surgery in Hong Kong and China
  • Performed the world's first robotic colorectal surgery using the da Vinci SP Surgical System
  • Conducted the world's first multi-specialty clinical trial using the next generation single port robotic surgical system
  • Early adoption of transanal total mesorectal excision (TME) and hosted the first training workshop in Hong Kong
  • Conducted the world's first randomised controlled trial comparing transanal and robotic TME
  • Pioneered colorectal endoscopic submucosal dissection in Hong Kong
  • Pioneered the application of integrative medicine (electroacupuncture and fast-track programme) in laparoscopic colorectal surgery
  • Established the first inflammatory bowel disease multidisciplinary team (MDT) clinic in Hong Kong
PEOPLE
Academic Staff
Professor NG Siu Man Simon Professor
Dr MAK Wing Chung Tony Associate Professor
Dr FUTABA Kaori Assistant Professor
HA Staff
Dr LEE Fung Yee Janet Consultant
Dr NGO Kwok Yu Dennis Associate Consultant
Dr CHU Simon Associate Consultant
Dr HO Man Fung Associate Consultant
Dr YIP Siu Man Tommy Associate Consultant
Dr KO Choi Wah Rachel Associate Consultant
Dr AU YEUNG Kit Ying Kitty Resident
Dr LAM Cheuk Ho Ray Resident

SELECTED PUBLICATIONS

  • Sun D, Liao D, Chen SC, Wong C, Leung WW, Futaba K, Mak T, Ng S, Gregersen H.
    Mechanophysiological analysis of anorectal function using simulated feces in human subjects.
    J Adv Res 2020 July 11. [Epub ahead of print].
  • COVIDSurg Collaborative (Collaborators: Futaba K, Ng S).
    Global guidance for surgical care during the COVID-19 pandemic.
    Br J Surg 2020 Apr 15. [Epub ahead of print].
  • Lee JM, Chung T, Kim KM, Ng SS, Han YD, Cho MS, Hur H, Lee KY, Kim NK, Lee SB, Kim GR, Min BS.
    Significance of Radial Margin in Patients Undergoing Complete Mesocolic Excision for Colon Cancer.
  • Gregersen H, Chen SC, Leung WW, Wong C, Mak T, Ng S, Futaba K.
    Novel Fecobionics Defecatory Function Testing.
    Clin Transl Gastroenterol 2019; 10: e00108.
  • Dong Y, Zhang Y, Kang W, Wang G, Chen H, Higashimori A, Natkatsu G, Go M, Tong JHM, Zheng S, To KF, Sung JJY, Yang X, Ng SSM, Yu J.
    VSTM2A suppressed colorectal cancer as a novel Wnt antagonist by directly causing LRP6 degradation.
    Theranostics 2019; 9: 6517-6531.
  • Wong SH, Kwong TNY, Chow TC, Luk AKC, Dai RZW, Nakatsu G, Lam TYT, Zhang L, Wu JCY, Chan FKL, Ng SSM, Wong MCS, Ng SC, Wu WKK, Yu J, Sung JJY.
    Quantitation of faecal Fusobacterium improves faecal immunochemical test in detecting advanced colorectal neoplasia.
    Gut 2017; 66: 1441-1448.
  • Marks J, Ng S, Mak T.
    Robotic transanal surgery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study.
    Tech Coloproctol 2017; 21: 541-545.
  • Yeung WW, Ma BB, Lee JF, Ng SS, Cheung MH, Ho WM, Tsang MW, Chu S, Lam DC, Mo FK.
    Clinical outcome of neoadjuvant chemoradiation in locally advanced rectal cancer at a tertiary hospital.
    Hong Kong Med J 2016; 22: 546-555.
  • Mak TW, Leung WW, Ngo DK, Lee JF, Hon SS, Ng SS.
    Translation and validation of the traditional Chinese version of the faecal incontinence quality of life scale.
    Int J Colorectal Dis 2016; 31: 445-450.
  • Park JS, Sakai Y, Ng SS, Law WL, Kim HR, Oh JH, Cheung HY, Kwak SG, Choi GS.
    Long-Term Survival and Local Relapse Following Surgery Without Radiotherapy for Locally Advanced Upper Rectal Cancer: An International Multi-Institutional Study.
    Medicine (Baltimore) 2016; 95: e2990.

  • Hon SS, Ng SS, Wong TC, Chiu PW, Mak TW, Leung WW, Lee JF.
    Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia.
    World J Gastroenterol Endosc 2015; 7: 1243-1249.
  • Ng SS, Lee JF, Yiu RY, Li JC, Hon SS, Mak TW, Leung WW, Leung KL.
    Long-Term Oncologic Outcomes of Laparoscopic Versus Open Surgery for Rectal Cancer: A Pooled Analysis of 3 Randomized Controlled Trials.
    Ann Surg 2014; 259: 139-147.
  • Ng SS, Lee JF, Yiu RY, Li JC, Hon SS, Mak TW, Ngo DK, Leung WW, Leung KL.
    Laparoscopic-assisted versus open total mesorectal excision with anal sphincter preservation for mid and low rectal cancer: a prospective randomized trial.
    Surg Endosc 2014; 28: 297-306.
  • Ng SS, Leung WW, Mak TW, Hon SS, Li JC, Wong CY, Tsoi KK, Lee JF.
    Electroacupuncture Reduces Duration of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer.
    Gastroenterology 2013; 144: 307-313.
  • Wu CW, Ng SS, Dong Y, Ng SC, Leung WW, Lee CW, Wong YN, Chan FK, Yu J, Sung JJ.
    Detection of miR-92a and miR-21 in stool samples as potential screening biomarkers for colorectal cancer and polyps.
    Gut 2012; 61: 739-745.
  • Li JC, Leung KL, Ng SS, Liu SY, Lee JF, Hon SS.
    Laparoscopic-assisted versus open resection of right-sided colonic cancer – a prospective randomized controlled trial.
    Int J Colorectal Dis 2012; 27: 95-102.
  • Hon SS, Ng SS, Chiu PW, Chan FK, Ng EK, Li JC, Lee JF, Leung KL.
    Endoscopic submucosal dissection versus local excision for early rectal neoplasms: a comparative study.
    Surg Endosc 2011; 25: 3923-3927.
  • Ng EK, Chong WW, Jin H, Lam EK, Shin VY, Yu J, Poon TC, Ng SS, Sung JJ.
    Differential expression of microRNAs in plasma of colorectal cancer patients: A potential marker for colorectal cancer screening.
    Gut 2009; 58: 1375-1381.
  • Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS.
    Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial.
    Dis Colon Rectum 2009; 52: 558-566.
  • Sung JJ, Lau JY, Young GP, Sano Y, Chiu HM, Byeon JS, Yeoh KG, Goh KL, Sollano J, Rerknimitr R, Matsuda T, Wu KC, Ng SS, Leung SY, Makharia G, Chong VH, Ho KY, Brooks D, Lieberman DA, Chan FK: for the Asia Pacific Working Group on Colorectal Cancer.
    Asia-Pacific consensus recommendations for colorectal cancer screening.
    Gut 2008; 57: 1166-1176.
  • Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW.
    Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial.
    Ann Surg Oncol 2008; 15: 2418-2425.
  • Ng SS, Lee JF, Yiu RY, Li JC, Hon SS.
    Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer: Report of the first case in Hong Kong and China with an updated literature review.
    World J Gastroenterol 2007; 13: 2514-2518.
  • Ng SS, Li JC, Lee JF, Yiu RY, Leung KL.
    Laparoscopic total colectomy for colorectal cancers: a comparative study.
    Surg Endosc 2006; 20: 1193-1196.
  • Ng SS, Leung KL, Lee JF, Yiu RY, Li JC.
    MRC CLASICC trial.
    Lancet 2005; 366: 713.
  • Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY.
    Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial.
    Lancet 2004; 363: 1187-1192.



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