At Mount Elizabeth Hospital and Gleneagles Hospital, Dr Tan Ek Khoon takes on some of the toughest challenges in surgery – from life-saving liver transplants to complex cancer operations of the liver, pancreas, bile duct and gallbladder.
With more than 15 years of clinical experience, he is a liver transplant surgeon who works with a multidisciplinary team to support patients through evaluation, surgery and long-term recovery. He is also an accomplished HPB surgeon, performing both open and minimally invasive (laparoscopic and robotic) procedures for complex conditions of the liver, pancreas, bile duct and gallbladder.
Dr Tan completed a 2-year abdominal organ transplant fellowship at the Mayo Clinic, Rochester (USA), accredited by the American Society of Transplant Surgeons, and has held several national leadership roles in advancing liver transplant care.
In this interview, he shares his insights on living donor liver transplantation, the advances shaping HPB cancer surgery, and the patient stories and values that keep him motivated in such high-stakes work.
After more than 15 years as a surgeon, how has your approach in the operating theatre evolved?
Over the years, my techniques have evolved through experience, continuous learning and reflection. I’ve refined how I handle tissue, control bleeding and approach complex anatomy. This has helped me operate more efficiently and gently, and in reducing blood loss during surgery. It’s always an ongoing process, and it’s important never to be complacent. I’m always thinking of how I can do better with each patient.
You’ve chaired national committees and led value-driven care initiatives. How has this influenced your work?
These roles have helped me understand healthcare as a whole system, rather than just the patient in front of me. It gave me insight into health policy, cost drivers, outcomes measurement and the value of standardisation. Being a good surgeon isn’t just about technical skills; it’s also about ensuring patients get the outcomes they need.
What’s your role in Mount Elizabeth’s liver transplant team?
In the liver transplant team, my role spans the entire journey for patients who require a liver transplant, especially those needing a living donor liver transplant (LDLT). This includes assessing suitability, planning the operation with our multidisciplinary team, performing the surgery, and supporting recovery and long-term follow-up.
Liver transplants require a whole team. How do you work with others to plan and carry out a successful transplant?
As a team we collect input from many specialists – hepatologists, cardiologists, pulmonologists, anesthesiologists, intensivists – to make sure the patient’s heart, lungs and other organs can withstand surgery. Together, we review scans to check the anatomy and also evaluate the patient’s social support and their commitment to long-term follow-up. It really is a team effort from start to finish.
In your view, what sets Mount Elizabeth apart for liver transplant surgeries?
I would attribute it to the close-coordination and combined experience of the team. From the ICU to the operating theatre to the wards, everyone comes together quickly when a transplant needs to be done. Having standardised processes and an experienced, multidisciplinary group allows us to deliver safe and reliable outcomes.
Can you walk us through the stages of a liver transplant – from assessment to recovery?
It starts with determining whether a transplant will make a meaningful difference to the patient’s survival and quality of life. The detailed assessment includes whether the patient needs a transplant, whether they are fit enough for the surgery, and whether it is the right time. During surgery, I focus on meticulous dissection, vascular and biliary reconstruction, and controlling the blood loss. Afterwards, the patient is monitored closely for complications and started on medications and other rehabilitation procedures till they have recovered.
Living donor liver transplant is especially complex. Why is that?
In LDLT, we are looking after two people – the donor and the recipient. The planning is very detailed to make sure the donor graft size is adequate, and the anatomy is suitable. All this while ensuring the donor’s safety, which is paramount. Although it is technically demanding, the advantage is that surgery can be scheduled in a timely manner before the patient deteriorates further.
How have success rates for LDLT changed over the years?
Liver transplantation has improved dramatically. It is now a very routine and standardised procedure, and in well-selected patients, the one-year survival is above 90%. Today, outcomes are better than before.
Being told you need a liver transplant can feel overwhelming. What do you usually say to patients and families at that moment?
It is usually a very big piece of news to receive, and it can feel daunting. I usually let patients and families share their concerns first. Then I spend however much time it takes to explain the risks and possible complications, but also how the team minimizes them and supports the patient. It is equally important for them to know that with advanced liver disease, choosing not to undergo treatment will almost certainly lead to deterioration. I try to guide them to make a timely decision, because acting before things get too dire often gives the best chance of success.
How do you decide if someone is a suitable candidate – and what if they’re not?
We look at their overall health, their imaging scans, whether the transplant will improve quality of life, and whether they have the social support and commitment needed for long-term follow-up. If they are not suitable for a transplant, it doesn’t mean we stop caring for them. There are medications, radiological procedures, and sometimes palliative care to maintain comfort. The key is in tailoring the best plan for each patient.
What are some common misconceptions you’ve heard?
One is that transplant patients will never return to good health. That isn’t true; many regain their health fully. In fact, there is an event called the Transplant Games where recipients compete in sporting competitions and it is a great example of how well patients can do after a transplant, both physically and emotionally.
Another misconception is that living donors won’t recover. The liver has a tremendous ability to regenerate, and donors usually restore themselves fully. Some also think patients can be “too old” or “not sick enough” to undergo a transplant. Every patient and case is unique, and assessment is key.
What does “compassionate care” look like to you?
It means seeing the patient beyond the illness – understanding the person, their hopes and fears, and walking with them through the ups and downs. It means taking the time to explain things clearly, even when it is busy.
Being honest but gentle when the news is difficult. And being there to encourage when the journey is not easy. In transplant, which is very high stakes, compassion is what keeps the care human. It builds trust, and trust between the patient, family and team can make all the difference.
Share with us a patient story that stayed with you.
A young man came in with acute liver failure and his wife was pregnant at the time. Fortunately, a family member stepped forward quickly as a donor and we performed the liver transplant. Months later we received a note with a photo of the patient with his newborn child. That stayed with me, because it reminded me that sometimes you’re not only giving health back to a patient, but also a father and a husband back to a family.
HPB cancer surgery is known to be especially complex. What drew you to this field, and what keeps you motivated?
I find it a privilege to care for patients who face serious, life-changing diagnoses. The treatment is complex and requires planning and technical skills. But it is rewarding to be able to offer patients a real plan or option, sometimes even when they have been told elsewhere that nothing more can be done.
Which HPB cases do you see most often?
Most commonly liver tumours, both primary liver cancer or cancer that has spread to the liver, often from the colon. I assess whether surgery is possible and if it will truly make a difference to survival and quality of life.
For patients with liver cancer or colorectal liver metastasis, how do you decide if surgery is right?
The most important factor is tumour biology – how the cancer behaves. I work closely with medical oncologists to guide decisions and consider whether it is something that will respond to surgery. Surgery is most effective when timed properly, not too early and not too late. Again, it is about whether it will make a meaningful difference for the patient.
Pancreatic cancer is challenging. How does the Whipple procedure help?
Pancreatic cancer is difficult to treat because it’s often detected late and it often involves nearby vital structures. The Whipple procedure is one of the procedures that can be performed for selected patients to remove the tumour, offering the best chance of long-term survival. Minimally invasive approaches - such as robotic Whipple’s - can reduce blood loss, wound complications and speed up recovery. But not every patient is suitable for a minimally invasive approach, and open surgery is still important when the anatomy is complicated or challenging.
Gallstones and bile duct stones are common. When does surgery become necessary?
If they (the gallstones) are silent, no surgery is needed. But once they cause pain, fever, jaundice or pancreatitis, or if stones are in the bile duct, then treatment is required to unblock the system and remove the gallbladder. These procedures are usually done minimally invasively, allowing a quick recovery.
Outside the operating theatre, how do you stay focused and energised?
I recharge by spending time with my family, having quiet time for reflection, and playing the piano. I find that it gives me the inner stillness I need so I can be fully present for patients.
If you hadn’t gone into medicine, what would you be doing today?
As a child I wanted to be a firefighter – I was probably drawn to meaning of helping people who needed it. Later I became interested in physics – I loved the idea of understanding how the universe works. Medicine, to me, somehow combines both: responding to patients’ needs through understanding how the body works.
Do you keep in touch with patients after surgery?
Yes, I do. One elderly patient always comes in cheerfully to tell me about his year – he even “trains” a little before his appointment so he’ll look his best. It’s very heart-warming and reminds me that my work doesn’t stop at the operating room.
