Improving surgical outcomes for Asian patients around the world:  opportunities for Taiwan

09:10 - 09:30, Room 104 (104講堂)

Department of Surgery

Massachusetts General Hospital

Harvard Medical School


Associate Professor

David C. Chang

Department of Surgery
Kaohsiung Medical University Hospital



King-Teh Lee



Abstract - 

Improving surgical outcomes for Asian patients around the world: opportunities for Taiwan

The United States (US) and Europe have led global advances in medical science for the last 200 years.  However, Asians remain a small minority in the US and in European countries.  In the US, for example, Asians make up approximately 5% of the population, or a total of approximately 15 million people.  This number is smaller than most Asian countries, even a small country like Taiwan.  It is unclear, therefore, whether current medical knowledge and treatments, which are developed from mostly white patient populations, are applicable to Asian patients.[1,2]  Emerging studies from the Massachusetts General Hospital (MGH), the flagship teaching hospital of the Harvard Medical School, and others suggest that they may not, and this problem can affect not only Asians living in the US and in Europe, but can also affect Asians around the world since most countries set their clinical practice based on US and European research. 


For example:

  • Breast cancer:  The US Preventive Services Task Force (USPSTF) recently changed the breast screening guideline to delay screening until age 50, based on American data showing that most breast cancer patients are in their 60s, and very few patients develop breast cancer under age 50.  However, a recent study from the MGH showed that this pattern only existed for white patients; but in all other racial groups—blacks, Hispanics, and Asians—the majority of breast cancer patients are in their 40s.  This is an example of clinical guidelines that are not suitable to Asian patients.

  • Leukemia:  A study from the NTU has found a stable survival difference between Taiwanese and US patients, suggesting the existence of an ethnic difference in chronic lymphocytic leukemia.

  • Blood clot prevention:  Prevention of blood clots is thought to be necessary for all patients after surgery.  However, in Asia, most surgeons do not prescribe blood thinners after surgery, based on their observations that Asian patients rarely develop blood clots.  Ongoing national studies at the MGH suggest similar patterns in the US, where Asian patients are found to be at lower risk for blood clots after surgery compared to white patients.

  • Bile duct injuries:  Studies at the MGH and at Johns Hopkins have shown that Asians are at higher risks for bile duct injuries during gall bladder surgery. A potential hypothesis being investigated is the possibility that Asian anatomy may be slightly different from the population norms documented in major text books. These textbooks describe common and minor anatomic variants in different body regions, but these text books are based on mostly white patients. It is possible that what is a minority pattern in white patients may actually be common in Asian patients, and the lack of awareness of these minor anatomic differences may lead to surgical injuries.


These findings suggest the important need for an organized effort to conduct research tailored to Asian patients, and to translate those research into innovative diagnostics and treatments, and new approach to teaching and training of future clinicians.


NTUH International Forum of Digestive Surgery & TY Lin Symposium

2020 台大醫院一般外科忘年會

2020 NTUH General Surgery Celebration Event

Multidisciplinary approach in pancreatic cancer




January 18th, 2020


​台大醫學院 104 講堂

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