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Kostakis ID, Dimitrokallis N, Iype S. Bridging locoregional treatment prior to liver transplantation for cirrhotic patients with hepatocellular carcinoma within the Milan criteria: a systematic review and meta-analysis. Ann Gastroenterol 2023; 36:449-458. [PMID: 37396004 PMCID: PMC10304529 DOI: 10.20524/aog.2023.0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background We performed a meta-analysis to assess the benefit of bridging locoregional treatment (LRT) before liver transplantation for cirrhotic patients with hepatocellular carcinoma (HCC) already within the Milan criteria at diagnosis. Methods We included original studies with HCC cases within the Milan criteria at diagnosis, comparing patients with and without bridging LRT before liver transplantation. Results Twenty-six retrospective original studies were included. Out of the 9068 patients within the Milan criteria, 6435 (71%) received bridging LRT and 2633 (29%) did not. The most frequent LRTs were transarterial chemoembolization, radiofrequency ablation, and microwave ablation. Most of the patient and tumor characteristics were similar between the 2 groups. Maximum tumor diameter on scans was slightly larger in the LRT arm (mean difference: 0.36 cm, 95% confidence interval [CI] 0.11-0.61; I2=79%). The LRT group also had multifocal disease slightly more frequently (risk ratio [RR] 1.21, 95%CI 1.04-1.41; I2=0%) and disease extent outside the Milan criteria (RR 1.3, 95%CI 1.03-1.66; I2=0%) on pathological examination of explanted livers. There was no difference between the 2 arms in the waiting time for transplant, dropout rates, disease-free survival at 1, 3, 5 years after transplant, or overall survival at 3 and 5 years after transplant. However, cases with LRT had better overall survival at 1 year after transplant (hazard ratio 0.54, 95%CI 0.35-0.86; I2=0%). Conclusions The precise benefit of bridging LRT for cirrhotic patients with HCC within the Milan criteria at diagnosis is unclear. There may be an advantage regarding short-term overall survival after liver transplantation.
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Affiliation(s)
- Ioannis D. Kostakis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Nikolaos Dimitrokallis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Satheesh Iype
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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Angelis A, Kostakis ID, Lilimpakis K, Kalaitzopoulou E, Papadea P, Skipitari M, Georgiou CD, Vagianos C. Time-Related Evidence of Intestinal Oxidative Stress in Obstructive Jaundice-Induced Rats. Eur Surg Res 2023; 64:323-333. [PMID: 36921589 DOI: 10.1159/000530087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Obstructive jaundice is known to affect intestinal permeability and facilitate bacterial translocation through related mechanisms. This study was conducted to evaluate the alterations concerning blood biochemistry and levels of several markers of oxidative stress (OS) in blood and intestinal mucosa caused by obstructive jaundice and how these fluctuate over time, in order to further explore the possibility of intervening in the OS path in future experiments. METHODS A total of 54 albino Wistar rats were randomly divided into three groups (control, sham operated, and bile duct ligation) and sacrificed at specific time intervals (12 h and 2, 7, and 14 days). The intestinal barrier function was evaluated by measuring endotoxin levels in portal, aortic, and peripheral blood. Also, basic biochemical parameters were simultaneously measured in peripheral blood. Tissue samples collected from the terminal ileum were homogenized for determining the OS markers, lipid peroxidation, and protein-free radical-induced oxidation. RESULTS We designed this experiment to examine the alterations in enteric mucosa primarily in relation to OS in a period of 14 days. During this time period, we investigated in specific time intervals not only OS fluctuations but also other liver function parameters, as well as CRP and endotoxin levels. The alterations were monitored in relation to time after bile duct ligation. CONCLUSION Bile duct ligation in rats causes OS versus post-ligation time progression of the common bile duct. OS was increased by ∼50% compared to control/sham and peaked at 7 days and at least up to 14 days post-ligation. This phenomenon was accompanied with a deranging of liver function after ligation, as anticipated, but not in all measured parameters; biochemical and endotoxin levels followed the same pattern.
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Affiliation(s)
- Apostolos Angelis
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Costas Vagianos
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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Kostakis ID, Raptis DA, Davidson BR, Iype S, Nasralla D, Imber C, Sharma D, Pissanou T, Pollok JM. Donor-Recipient Body Surface Area Mismatch and the Outcome of Liver Transplantation in the UK. Prog Transplant 2023; 33:61-68. [PMID: 36537056 DOI: 10.1177/15269248221145035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Too small or too big liver grafts for recipient's size has detrimental effects on transplant outcomes. Research Questions: The purpose was to correlate donor-recipient body surface area ratio or body surface area index with recipient survival, graft survival, hepatic artery or portal vein, or vena cava thrombosis. High and low body surface area index cut-off points were determined. Design: There were 11,245 adult recipients of first deceased donor whole liver-only grafts performed in the UK from January 2000 until June 2020. The transplants were grouped according to the body surface area index and compared to complications, graft and recipient survival. Results: The body surface area index ranged from 0.491 to 1.691 with a median of 0.988. The body surface area index > 1.3 was associated with a higher rate of portal vein thrombosis within the first 3 months (5.5%). This risk was higher than size-matched transplants (OR: 2.878, 95% CI: 1.292-6.409, P = 0.01). Overall graft survival was worse in transplants with body surface area index ≤ 0.85 (HR: 1.254, 95% CI: 1.051-1.497, P = 0.012) or body surface area index > 1.4 (HR: 3.704, 95% CI: 2.029-6.762, P < 0.001) than those with intermediate values. The graft survival rates were reduced by 2% for cases with body surface area index ≤ 0.85 but were decreased by 20% for cases with body surface area index > 1.4. These findings were confirmed by bootstrap internal validation. No statistically significant differences were detected for hepatic artery thrombosis, occlusion of hepatic veins/inferior vena cava or recipient survival. Conclusions: Donor-recipient size mismatch affects the rates of portal vein thrombosis within the first 3 months and overall graft survival in deceased-donor liver transplants.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Dimitri Aristotle Raptis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Brian R Davidson
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Satheesh Iype
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - David Nasralla
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Charles Imber
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Dinesh Sharma
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Theodora Pissanou
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
| | - Joerg Matthias Pollok
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, 4965Royal Free London NHS Foundation Trust, London, UK
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Kostakis ID, Chandak P, Assia-Zamora S, Gogalniceanu P, Loukopoulos I, Calder F, Stojanovic J, Kessaris N. Pediatric renal transplantation-A UNOS database analysis of donor-recipient size mismatch. Pediatr Transplant 2023; 27:e14470. [PMID: 36651195 DOI: 10.1111/petr.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND We used the BSAi (Donor BSA/Recipient BSA) to assess whether transplanting a small or large kidney into a pediatric recipient relative to his/her size influences renal transplant outcomes. METHODS We included 14 322 single-kidney transplants in pediatric recipients (0-17 years old) (01/2000-02/2020) from the United Network for Organ Sharing database. We divided cases into four BSAi groups (BSAi ≤ 1, 1 < BSAi ≤ 2, 2 < BSAi ≤ 3, BSAi > 3). RESULTS There were no differences concerning delayed graft function (DGF) or primary non-function (PNF) rates, whether the grafts were from living or brain-dead donors. In both transplants coming from living donors and brain-dead donors, cases with BSAi > 3 and cases with 2 < BSAi ≤ 3 had similar graft survival (p = .13 for transplants from living donors, p = .413 for transplants from brain-dead donors), and both groups had longer graft survival than cases with 1 < BSAi ≤ 2 and cases with BSAi ≤ 1 (p < .001). The difference in 10-year graft survival rates between cases with BSAi > 3 and cases with BSAi ≤ 1 reached around 25% in both donor types. The better graft survival in transplants with BSAi > 2 was confirmed in multivariable analysis. CONCLUSIONS There is no significant impact of donor-recipient size mismatch on DGF and PNF rates in pediatric renal transplants. However, graft survival is significantly improved when the donor's size is more than twice the pediatric recipient's size.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Department of Hepato-Pancreato-Biliary Surgery and Liver transplantation, Royal Free Hospital, London, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | - Sergio Assia-Zamora
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK.,Institute of Liver Studies, King's College Hospital, UK
| | - Petrut Gogalniceanu
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK.,Institute of Liver Studies, King's College Hospital, UK
| | - Ioannis Loukopoulos
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | - Francis Calder
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
| | | | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK.,Nephrology Department, Great Ormond Street Hospital, London, UK
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Parianos C, Kyriakopoulos G, Kostakis ID, Nasiri-Ansari N, Aggeli C, Dimitriadi A, Angelousi A, Papavassiliou AG, Kaltsas GA, Zografos G, Kassi E. Adrenocortical Cancer: A 20-Year Experience of a Single Referral Center in Prognosis and Outcomes. Horm Metab Res 2021; 53:709-716. [PMID: 34740271 DOI: 10.1055/a-1666-9026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare but very aggressive endocrine malignancy with poor survival. Histopathology is important for diagnosis, while in some cases immunohistochemical markers and gene profiling of the resected tumor may be superior to current staging systems to determine prognosis. We aimed to present the 20-year experience at a tertiary hospital in patients with ACCs and correlate the immunohistochemical characteristics of ACCs with the clinical and morphological characteristics of the tumors and the survival of the patients. Forty-five patients with ACC were included in the study. All the resections were R0. The tumor size and weight, the disease stage (ENSAT classification), Weiss score and Helsinki score were examined along with immunohistochemical expression of inhibin-A, melan A, calretinin, Ki67, synaptophysin, p53, vimentin, CKAE1/AE3. The male to female ratio was 1:1.37. The median age at diagnosis was 55.5 years (IQR 19-77). The median size of ACCs was 9 cm (IQR 3.5-22 cm) and the median weight 127 g (IQR 18-1400 g). The median follow up period was 18 months (IQR 1-96). Ki67 varied from<1% to 75% (median: 16.4%). The expression of melan-A and lower expression of Ki-67 (≤4) were independently associated with longer OS time (p=0.01 and p=0.04, respectively). In multivariable analysis, tumor volume>400 cm3 (p=0.046), Weiss score>5 (p=0.007) and overexpression of p53 (p=0.036) were independent risk factors for shorter survival. Adrenocortical carcinoma is a rare and very aggressive endocrine malignancy. The most important factors that determine long-term prognosis of ACC are the disease stage at diagnosis, the Weiss score, and the Ki67 index. Immunohistochemical markers such as melan A could also serve as prognostic factors.
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Affiliation(s)
- Christos Parianos
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece
- Department of Surgery, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Georgios Kyriakopoulos
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece
- Department of Pathology, Evaggelismos Hospital, Athens, Greece
| | - Ioannis D Kostakis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Narjes Nasiri-Ansari
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysanthi Aggeli
- Department of Surgery, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Anastasia Dimitriadi
- Department of Pathology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Anna Angelousi
- Unit of Endocrinology, First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gregory A Kaltsas
- Unit of Endocrinology, First Department of Propaedeutic Internal Medicine, Laiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - George Zografos
- Department of Surgery, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Eva Kassi
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece
- Unit of Endocrinology, First Department of Propaedeutic Internal Medicine, Laiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Neradova A, Vajgel G, Hendra H, Antonelou M, Kostakis ID, Wright D, Masson P, Milne SE, Jones G, Salama A, Davenport A, Burns Á. Frailty score before admission as risk factor for mortality of renal patients during the first wave of the COVID pandemic in London. G Ital Nefrol 2021; 38:38-03-2021-02. [PMID: 34169690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged ≥18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission. Results: A total of 200 renal patients were SARS-Cov-2 positive. In the 174 patients who had a CFS recorded, the age was 65.4 years ± 15.8 (mean ± SD) and 57,5% were male. At the end of follow up, 26% had died. Frail patients (CFS 5-7) were more than three times more likely to die compared to less frail patients (CFS of 1-4) (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.0-10.6). 118 patients (68%) required admission, but there was no difference in hospital admission rates for frail vs non-frail patients (OR 0.6, CI 0.3-1.7). Conclusions: Frailty is a better predictor of mortality than age and co-morbidities in COVID-19 positive renal patients.
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Affiliation(s)
- Aegida Neradova
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Dianet Amsterdam, Amsterdam UMC Department of Nephrology, Amsterdam, The Netherlands
| | - Gisele Vajgel
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK; Nephrology Department, Hospital das Clinicas - Federal University of Pernambuco (HC-UFPE), Brazil; Laboratório Imunopatologia Keizo Azami - Federal University of Pernambuco (LIKA/UFPE), Brazil
| | - Heidy Hendra
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Marilina Antonelou
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - David Wright
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Philip Masson
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Sarah E Milne
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Gareth Jones
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Alan Salama
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK; Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, UK
| | - Andrew Davenport
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
| | - Áine Burns
- Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, UK
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Kostakis ID, Feretis T, Damaskos C, Garmpis N, Liapis G, Pateras I, Garmpi A, Georgakopoulou VE, Antoniou EA. Nuchal-type Fibroma: Single-Center Experience and Systematic Literature Review. In Vivo 2021; 34:2217-2223. [PMID: 32871744 DOI: 10.21873/invivo.12032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nuchal-type fibroma is a rare benign tumor arising from the connective tissue. Our aim was to present our experience via two cases of this tumor and a comprehensive review of the literature. PATIENTS AND METHODS We report a case of a 23-year-old female with a mass located in the posterior neck and the upper back and a case of a 50-year-old male with a mass located in the posterior neck, which were proved to be nuchal-type fibromas in the histopathological examination. We also searched the PubMed/Medline database for published cases of nuchal-type fibromas. RESULTS AND DISCUSSION Nuchal-type fibroma is a rare benign tumor arising from the connective tissue, usually in the posterior neck, which affects different ages, with most patients being male. It is a poorly circumscribed tumor consisting of hypocellular, thick, dense and haphazardly arranged collagen bundles with entrapped adipocytes, nerve fibers and muscle fascicles and a few scattered spindle cells, which are CD34 positive. Its excision is curative, and the recurrence risk is generally low. However, patients with Gardner's syndrome may experience recurrence more frequently. CONCLUSION Nuchal-type fibroma should be included in the differential diagnosis of subcutaneous, soft-tissue masses, especially when these involve the posterior neck.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - Themistoklis Feretis
- First Department of Endoscopic Surgery, Metropolitan General Hospital, Athens, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Liapis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pateras
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki E Georgakopoulou
- Department of Pulmonology, Laiko General Hospital, Athens, Greece.,First Department of Pulmonology, Sismanogleio Hospital, Athens, Greece
| | - Efstathios A Antoniou
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kostakis ID, Iype S, Nasralla D, Davidson BR, Imber C, Sharma D, Pollok JM. Combining Donor and Recipient Age With Preoperative MELD and UKELD Scores for Predicting Survival After Liver Transplantation. EXP CLIN TRANSPLANT 2021; 19:570-579. [PMID: 34085606 DOI: 10.6002/ect.2020.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The end-stage liver disease scoring systems MELD, UKELD, and D-MELD (donor age × MELD) have had mediocre results for survival assessment after orthotopic liver transplant. Here, we introduced new indices based on preoperative MELD and UKELDscores and assessed their predictive ability on survival posttransplant. MATERIALS AND METHODS We included 1017 deceased donor orthotopic liver transplants that were performed between 2008 (the year UKELD was introduced) and 2019. Donor and recipient characteristics, liver disease scores, transplant characteristics, and outcomes were collected for analyses. D-MELD, D-UKELD (donor age × UKELD),DR-MELD[(donor age + recipient age) × MELD], and DR-UKELD [(donor age + recipient age) × UKELD] were calculated. RESULTS No score had predictive value for graft survival. For patient survival,DR-MELD and DR-UKELD provided the best results but with low accuracy. The highest accuracy was observed at 1 year posttransplant (areas under the curve of 0.598 [95% CI, 0.529-0.667] and 0.609 [95% CI, 0.549-0.67]forDR-MELDandDR-UKELD). Addition of donor and recipient age significantly improved the predictive abilities of MELD and UKELD for patient survival, but addition of donor age alone did not. For 1-year mortality (using receiver operating characteristic curves), optimal cut-off points were DR-MELD>2345 and DR-UKELD>5908. Recipients with DR-MELD >2345 (P < .001) and DR-UKELD >5908 (P = .002) had worse patient survival within the first year, but only DR-MELD >2345 remained significant after multivariable analysis (P = .007). CONCLUSIONS DR-MELD and DR-UKELD scores provided the best, albeit mediocre, predictive ability among the 6 tested models, especially at 1 year after posttransplant, although only for patient but not for graft survival. A DR-MELD >2345 was considered to be an additional independent risk factor for worse recipient survival within the first postoperative year.
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Affiliation(s)
- Ioannis D Kostakis
- From the Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK; and the Division of Surgery and Interventional Science, University College London, London, UK
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9
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Kostakis ID, Karydis N, Kassimatis T, Kessaris N, Loukopoulos I. The implications of donor-recipient size mismatch in renal transplantation. J Nephrol 2021; 34:2037-2051. [PMID: 34033003 DOI: 10.1007/s40620-021-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Transplanting kidneys small for recipient's size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient. METHODS We included 26,223 adult single kidney transplants (01/01/2007-31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 < BSA ≤ 1, 1 < BSAi ≤ 1.25, BSAi > 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75). RESULTS Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 < BSAi ≤ 1: OR = 0.59, 95% CI = 0.32-1.1, p = 0.095, 1 < BSAi ≤ 1.25: OR = 0.46, 95% CI = 0.23-0.89, p = 0.022, BSAi > 1.25: OR = 0.32, 95% CI = 0.13-0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 < BSAi ≤ 1: OR = 0.72, 95% CI = 0.55-0.96, p = 0.024, 1 < BSAi ≤ 1.25: OR = 0.62, 95% CI = 0.47-0.83, p = 0.001, BSAi > 1.25: OR = 0.65, 95% CI = 0.47-0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 < BSAi ≤ 1: HR = 0.55, 95% CI = 0.41-0.74, p < 0.001, 1 < BSAi ≤ 1.25: HR = 0.48, 95% CI = 0.35-0.66, p < 0.001, BSAi > 1.25: HR = 0.45, 95% CI = 0.31-0.66, p < 0.001). Ten-year graft survival rate was 58.4% for renal transplants from donors after circulatory death with BSAi ≤ 0.75. CONCLUSIONS Delayed graft function risk is higher in renal transplants with BSAi ≤ 0.75 coming from living donors and donors after brain death. Graft survival is greatly reduced in renal transplants from donors after circulatory death with BSAi ≤ 0.75.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
| | - Nikolaos Karydis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Theodoros Kassimatis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Allam M, Hidalgo Salinas C, Machairas N, Kostakis ID, Watkins J, Fusai GK. Solid Pseudopapillary Neoplasms of the Pancreas: a Single-Center Experience and Review of the Literature. J Gastrointest Cancer 2021; 53:460-465. [PMID: 33877570 DOI: 10.1007/s12029-021-00638-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. METHODS All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed. RESULTS During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16-66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23 months, no tumour recurrence or death was recorded. CONCLUSION In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.
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Affiliation(s)
- Moustafa Allam
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Camila Hidalgo Salinas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK.
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
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11
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Hendra H, Vajgel G, Antonelou M, Neradova A, Manson B, Clark SG, Kostakis ID, Caplin B, Salama AD. Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty. J Nephrol 2021; 34:315-323. [PMID: 33515380 PMCID: PMC7846911 DOI: 10.1007/s40620-020-00960-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The pandemic of coronavirus disease (COVID-19) has highly affected patients with comorbidities and frailty who cannot self-isolate, such as individuals undergoing haemodialysis. The aim of the study was to identify risk factors for mortality and hospitalisation, which may be useful in future disease spikes. METHODS We collected data retrospectively from the electronic medical records of all patients receiving a diagnosis of COVID-19 between 11th March and 10th May 2020 undergoing maintenance haemodialysis at four satellite dialysis units from the Royal Free London NHS Foundation Trust, London, UK. Mortality was the primary outcome, and the need for hospitalization was the secondary one. RESULTS Out of 746 patients undergoing regular haemodialysis, 148 symptomatic patients tested positive for SARS-CoV-2 by RT-PCR and were included in the analysis. The overall mortality rate was 24.3%. By univariate analysis, older age, ischaemic heart disease, lower systolic blood pressure, lower body mass index (BMI) and higher frailty scores were associated with higher rates of mortality (all p value < 0.05). The laboratory factors associated with mortality were higher values of WBC, neutrophil counts, neutrophil to lymphocyte ratios (NLR), C-reactive protein (CRP), bilirubin, ferritin, troponin, and lower serum albumin level (all p value < 0.05). In the logistic regression, mortality was associated with older age and higher CRP, while high levels of NLR and CRP were associated with the need for hospitalization. DISCUSSION Haemodialysis patients are susceptible to COVID-19 and have a high mortality rate. Our study identifies prognostic risk factors associated with poor outcome including age, frailty and markers of inflammation, which may support more informed clinical decision-making.
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Affiliation(s)
- Heidy Hendra
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Gisele Vajgel
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
- Department of Nephrology, Hospital das Clinicas, Federal University of Pernambuco (HC-UFPE), Recife, Brazil
- Laboratório Imunopatologia Keizo Asami, Federal University of Pernambuco (LIKA/UFPE), Recife, Brazil
| | - Marilina Antonelou
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Aegida Neradova
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Dianet Amsterdam, Amsterdam UMC Department of Nephrology, Amsterdam, The Netherlands
| | - Bethia Manson
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Grace Clark
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Ioannis D Kostakis
- Department of Hepatobiliary Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Ben Caplin
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK
| | - Alan D Salama
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK.
- Department of Renal Medicine, Royal Free Campus, UCL, Rowland Hill Street, London, NW3 2PF, UK.
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12
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Tampakis A, Tampaki EC, Nonni A, Kostakis ID, Posabella A, Kontzoglou K, von Flüe M, Felekouras E, Kouraklis G, Nikiteas N. Correction to: High fascin-1 expression in colorectal cancer identifies patients at high risk for early disease recurrence and associated mortality. BMC Cancer 2021; 21:191. [PMID: 33627068 PMCID: PMC7903637 DOI: 10.1186/s12885-021-07936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Athanasios Tampakis
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland. .,Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece.
| | - Ekaterini-Christina Tampaki
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Afrodite Nonni
- First Department of Pathology, School of Medicine, National University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Alberto Posabella
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Markus von Flüe
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland
| | - Evangelos Felekouras
- First Department of Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
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13
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Tampakis A, Tampaki EC, Nonni A, Kostakis ID, Posabella A, Kontzoglou K, von Flüe M, Felekouras E, Kouraklis G, Nikiteas N. High fascin-1 expression in colorectal cancer identifies patients at high risk for early disease recurrence and associated mortality. BMC Cancer 2021; 21:153. [PMID: 33579217 PMCID: PMC7881491 DOI: 10.1186/s12885-021-07842-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/26/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fascin is the main actin cross-linker protein that regulates adhesion dynamics and stabilizes cell protrusion, such as filopodia. In human cancer, fascin expression correlates with aggressive clinical features. This study aimed to determine the expression patterns of fascin-1 and assessed its prognostic significance in colorectal cancer. METHODS One hundred eleven specimens of patients with primary resectable colorectal cancer were examined via immunohistochemistry for the expression of fascin-1, and the results were correlated with clinicopathological characteristics and survival data. RESULTS Fascin-1 staining displayed strong intensity in the cytoplasm of the colorectal cancer cells and endothelial cells of tumor blood vessels. Moderate to high fascin-1 expression was associated with progressive anatomic disease extent (p < 0.001), higher T classification (p = 0.007), the presence of lymph node (p < 0.001) and distant metastasis (p = 0.002), high grade tumors (p = 0.002) and vascular invasion (p < 0.001). Patients displaying moderate and high fascin-1 expression demonstrated a significantly worse 5-year overall survival [HR; 3.906, (95%CI) = 1.250-12.195] and significantly worse 3-year progression-free survival [HR; 3.448, (95%CI) = 1.401-8.475] independent of other clinicopathological characteristics. Besides, high fascin-1 expression in early-stage cancer only was associated with a dismal prognosis. CONCLUSIONS High fascin-1 expression in colorectal cancer is an independent negative prognostic factor for survival, increasing the risk for disease recurrence or death almost by sevenfold. Fascin-1 expression could be potentially utilized to identify high-risk patients prone to metastasis already in early-stage disease.
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Affiliation(s)
- Athanasios Tampakis
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland. .,Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece.
| | - Ekaterini-Christina Tampaki
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Afrodite Nonni
- First Department of Pathology, School of Medicine, National University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Alberto Posabella
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Markus von Flüe
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital of Basel, Spitalstraße 21, 4031, Basel, Switzerland
| | - Evangelos Felekouras
- First Department of Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece
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14
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Machairas N, Kostakis ID, Schizas D, Kykalos S, Nikiteas N, Sotiropoulos GC. Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma. Updates Surg 2020; 73:59-68. [PMID: 33219937 DOI: 10.1007/s13304-020-00930-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): - 1.17 cm, 95% confidence intervals (CI) - 1.77 to - 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67-0.83, p < 0.00001] and R0 resections more frequently (RR: 1.05, 95% CI 1.01-1.09, p = 0.01), while lymphadenectomy was less common in the laparoscopic group (RR: 0.73, 95% CI 0.58-0.92, p = 0.007). The LLR group presented reduced blood loss (MD: - 270.16 ml, 95% CI - 381.53 to - 32.79, p = 0.002), need for transfusion (RR: 0.39, 95% CI 0.21-0.73, p = 0.003), overall morbidity (RR: 0.58, 95% CI 0.4-0.83, p = 0.003) and hospital stay (MD: - 3.48 days, 95% CI: - 6.94 to - 0.02, p = 0.05) compared to the OLR group. No differences were shown in operative time (MD: 1.6 min, 95% CI - 34.17-37.37, p = 0.93), major morbidity (RR: 0.65, 95% CI 0.38-1.11, p = 0.12), mortality (RR: 1.42, 95% CI 0.13-15.07, p = 0.77), overall (HR: 0.9, 95% CI 0.59-1.38, p = 0.63) and relapse-free survival (HR: 0.77, 95% CI 0.5-1.16, p = 0.21) between the two groups. LLR seems to benefit patients with iCCA in terms of short-term outcomes, whilst long-term outcomes are comparable among the two approaches.
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Affiliation(s)
- Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece. .,Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
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15
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Tsaparas P, Machairas N, Ardiles V, Krawczyk M, Patrono D, Baccarani U, Cillo U, Aandahl EM, Cotsoglou C, Espinoza JL, Claría RS, Kostakis ID, Foss A, Mazzaferro V, de Santibañes E, Sotiropoulos GC. Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: a multicenter analysis. Ann Gastroenterol 2020; 34:111-118. [PMID: 33414630 PMCID: PMC7774661 DOI: 10.20524/aog.2020.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy. Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed. Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively. Conclusion LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes.
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Affiliation(s)
- Peter Tsaparas
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Nikolaos Machairas
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Victoria Ardiles
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland (Marek Krawczyk)
| | - Damiano Patrono
- General Surgery 2U, Liver Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy (Damiano Patrono)
| | - Umberto Baccarani
- Liver Transplant Unit, Department of Medicine, University of Udine, Udine, Italy (Umberto Baccarani)
| | - Umberto Cillo
- Hepatobiliary and Liver Transplant Unit, University of Padova School of Medicine, Padova, Italy (Umberto Cillo)
| | - Einar Martin Aandahl
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway (Einar Martin Aandahl, Aksel Foss)
| | - Christian Cotsoglou
- Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy (Christian Cotsoglou)
| | - Johana Leiva Espinoza
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Rodrigo Sanchez Claría
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Ioannis D Kostakis
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos)
| | - Aksel Foss
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway (Einar Martin Aandahl, Aksel Foss)
| | - Vincenzo Mazzaferro
- Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy (Christian Cotsoglou)
| | - Eduardo de Santibañes
- Division of Hepatobiliary Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Victoria Ardiles, Johana Leiva Espinoza, Rodrigo Sanchez Claría, Eduardo de Santibañes)
| | - Georgios C Sotiropoulos
- 2 Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Peter Tsaparas, Nikolaos Machairas, Ioannis D. Kostakis, Georgios C. Sotiropoulos).,Department of General Visceral and Transplantation Surgery, University Hospital Essen, Germany (Georgios C. Sotiropoulos)
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16
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Kostakis ID, Loukopoulos I. Response to "results from a meta-analysis comparing bovine carotid artery grafts with polytetrafluoroethylene grafts must be interpreted with caution due to methodological flaws". J Vasc Access 2020; 22:854-855. [PMID: 32938317 DOI: 10.1177/1129729820954753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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17
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Kostakis ID, Kassimatis T, Flach C, Karydis N, Kessaris N, Loukopoulos I. Hypoperfusion warm ischaemia time in renal transplants from donors after circulatory death. Nephrol Dial Transplant 2020; 35:1628-1634. [DOI: 10.1093/ndt/gfaa160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The donor hypoperfusion phase before asystole in renal transplants from donors after circulatory death (DCD) has been considered responsible for worse outcomes than those from donors after brain death (DBD).
Methods
We included 10 309 adult renal transplants (7128 DBD and 3181 DCD; 1 January 2010–31 December 2016) from the UK Transplant Registry. We divided DCD renal transplants into groups according to hypoperfusion warm ischaemia time (HWIT). We compared delayed graft function (DGF) rates, primary non-function (PNF) rates and graft survival among them using DBD renal transplants as a reference.
Results
The DGF rate was 21.7% for DBD cases, but ∼40% for DCD cases with HWIT ≤30 min (0–10 min: 42.1%, 11–20 min: 43%, 21–30 min: 38.4%) and 60% for DCD cases with HWIT >30 min (P < 0.001). All DCD groups showed higher DGF risk than DBD renal transplants in multivariable analysis {0–10 min: odds ratio [OR] 2.686 [95% confidence interval (CI) 2.352–3.068]; 11–20 min: OR 2.531 [95% CI 2.003–3.198]; 21–30 min: OR 1.764 [95% CI 1.017–3.059]; >30 min: OR 5.814 [95% CI 2.798–12.081]}. The highest risk for DGF in DCD renal transplants with HWIT >30 min was confirmed by multivariable analysis [versus DBD: OR 5.814 (95% CI 2.798–12.081) versus DCD: 0–10 min: OR 2.165 (95% CI 1.038–4.505); 11–20 min: OR 2.299 (95% CI 1.075–4.902); 21–30 min: OR 3.3 (95% CI 1.33–8.197)]. No significant differences were detected regarding PNF rates (P = 0.713) or graft survival (P = 0.757), which was confirmed by multivariable analysis.
Conclusions
HWIT >30 min increases the risk for DGF greatly, but without affecting PNF or graft survival.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Theodoros Kassimatis
- Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Clare Flach
- King’s College London, School of Population Health and Environmental Studies, London, UK
| | - Nikolaos Karydis
- Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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18
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Diamantopoulou A, Mantas D, Kostakis ID, Agrogiannis G, Garoufalia Z, Kavantzas N, Kouraklis G. A Clinicopathological Analysis of S100A14 Expression in Colorectal Cancer. In Vivo 2020; 34:321-330. [PMID: 31882495 DOI: 10.21873/invivo.11777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM The calcium-binding protein S100A14 is involved in processes related to tumorigenesis and tumor propagation, such as proliferation, apoptosis, motility and invasiveness. Our aim was to investigate its role in colorectal cancer. PATIENTS AND METHODS One hundred and seven patients (65 men and 42 women) were included in this study. They had been diagnosed with colorectal cancer and undergone complete resection of their primary tumor. Tissue samples from archival blocks of their normal and malignant colorectal tissues were used for immunohistochemical assessment of S100A14 expression. S100A14 levels were evaluated using image analysis and associated with various clinicopathological parameters and prognosis. RESULTS S100A14 expression was reduced in malignant tissues when compared to normal intestinal mucosa in cases of T3-T4 tumors (p=0.017). Moreover, as far as S100A14 levels in malignant tissues are concerned, they were lower in T3-T4 tumors (p=0.001), N2 disease (p=0.034) and M1 disease (p=0.019). Finally, very high S100A14 production (>75th percentile) was associated with shorter disease-specific (HR=3.584, p=0.045) and relapse-free survival (HR=4.527, p=0.007) in multivariate survival analysis. CONCLUSION S100A14 expression is decreased in advanced colorectal cancer. However, cases with very high S100A14 levels have a worse survival.
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Affiliation(s)
- Angela Diamantopoulou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George Agrogiannis
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Kavantzas
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Kostakis ID, Loukopoulos I. Comparison between bovine carotid artery graft and polytetrafluoroethylene graft for haemodialysis vascular access: A systematic review and meta-analysis. J Vasc Access 2020. [PMID: 32495711 DOI: 10.1177/1129729820926088.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a renewed interest in using bovine carotid artery grafts for haemodialysis vascular access after recent advances in conduit manufacturing and endovascular management of access-related complications. Our aim was to summarize the results of the recent studies comparing bovine carotid artery grafts with polytetrafluoroethylene grafts as vascular access for haemodialysis. METHODS A systematic review was conducted for original articles comparing bovine carotid artery with polytetrafluoroethylene grafts for haemodialysis vascular access published between January 2000 and December 2019 searching the databases of Medline, Scopus, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. RESULTS Four studies were included (one prospective randomized controlled trial and three retrospective studies) with 676 patients in total (bovine carotid artery: 395, polytetrafluoroethylene: 281). There was lower graft infection rate per patient-year in bovine carotid artery grafts (mean difference: -0.03, p < 0.0001). Bovine carotid artery grafts required fewer interventions per patient-year to maintain or restore patency (mean difference: -0.81, p = 0.002). No significant difference was detected regarding pseudoaneurysm formation (p = 0.24), steal syndrome (p = 0.11) or patency rates (primary: 1 year: p = 0.15, 2 years: p = 0.69; primary assisted: 1 year: p = 0.18, 2 years: p = 0.54; secondary: 1 year: p = 0.22, 2 years: p = 0.17). CONCLUSION Bovine carotid artery and polytetrafluoroethylene grafts have similar short-term and long-term outcomes, with a possible advantage of bovine carotid artery grafts concerning graft infections and number of required interventions. Thus, bovine carotid artery grafts can be a useful alternative modality for haemodialysis vascular access.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kostakis ID, Loukopoulos I. Comparison between bovine carotid artery graft and polytetrafluoroethylene graft for haemodialysis vascular access: A systematic review and meta-analysis. J Vasc Access 2020; 22:26-33. [PMID: 32495711 DOI: 10.1177/1129729820926088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is a renewed interest in using bovine carotid artery grafts for haemodialysis vascular access after recent advances in conduit manufacturing and endovascular management of access-related complications. Our aim was to summarize the results of the recent studies comparing bovine carotid artery grafts with polytetrafluoroethylene grafts as vascular access for haemodialysis. METHODS A systematic review was conducted for original articles comparing bovine carotid artery with polytetrafluoroethylene grafts for haemodialysis vascular access published between January 2000 and December 2019 searching the databases of Medline, Scopus, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. RESULTS Four studies were included (one prospective randomized controlled trial and three retrospective studies) with 676 patients in total (bovine carotid artery: 395, polytetrafluoroethylene: 281). There was lower graft infection rate per patient-year in bovine carotid artery grafts (mean difference: -0.03, p < 0.0001). Bovine carotid artery grafts required fewer interventions per patient-year to maintain or restore patency (mean difference: -0.81, p = 0.002). No significant difference was detected regarding pseudoaneurysm formation (p = 0.24), steal syndrome (p = 0.11) or patency rates (primary: 1 year: p = 0.15, 2 years: p = 0.69; primary assisted: 1 year: p = 0.18, 2 years: p = 0.54; secondary: 1 year: p = 0.22, 2 years: p = 0.17). CONCLUSION Bovine carotid artery and polytetrafluoroethylene grafts have similar short-term and long-term outcomes, with a possible advantage of bovine carotid artery grafts concerning graft infections and number of required interventions. Thus, bovine carotid artery grafts can be a useful alternative modality for haemodialysis vascular access.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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21
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Prodromidou A, Machairas N, Garoufalia Z, Kostakis ID, Kyriakidis AV, Spartalis E, Sotiropoulos GC. Ovarian inguinal hernia. Ann R Coll Surg Engl 2020; 102:75-83. [PMID: 31696731 PMCID: PMC6996425 DOI: 10.1308/rcsann.2019.0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa. METHODS A systematic search was conducted for literature published up to February 2018 using the MEDLINE®, Scopus® and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review. RESULTS Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy. CONCLUSIONS Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.
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22
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Kostakis ID, Sran H, Uwechue R, Chandak P, Olsburgh J, Mamode N, Loukopoulos I, Kessaris N. Comparison Between Robotic and Laparoscopic or Open Anastomoses: A Systematic Review and Meta-Analysis. Robot Surg 2019; 6:27-40. [PMID: 31921934 PMCID: PMC6934120 DOI: 10.2147/rsrr.s186768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis. METHODS A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations. RESULTS We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001). CONCLUSION Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Harkiran Sran
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Raphael Uwechue
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nizam Mamode
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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23
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Kontos M, Kostakis ID, Constantinidou A, Parkin A, Fletcher M, Coltman L, Beard S, Kumar I. Primary endocrine treatment for breast cancer in the elderly. Breast J 2019; 26:585-587. [PMID: 31495036 DOI: 10.1111/tbj.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Kontos
- First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Anastasia Constantinidou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Ann Parkin
- Breast Unit, Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Lucy Coltman
- Breast Unit, Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Inder Kumar
- Breast Unit, Rotherham NHS Foundation Trust, Rotherham, UK
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24
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Dimitriadis GK, Nasiri-Ansari N, Agrogiannis G, Kostakis ID, Randeva MS, Nikiteas N, Patel VH, Kaltsas G, Papavassiliou AG, Randeva HS, Kassi E. Empagliflozin improves primary haemodynamic parameters and attenuates the development of atherosclerosis in high fat diet fed APOE knockout mice. Mol Cell Endocrinol 2019; 494:110487. [PMID: 31195080 DOI: 10.1016/j.mce.2019.110487] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 02/08/2023]
Abstract
The effects of long-term treatment with empagliflozin on biochemical and immunohistochemical markers related to atherosclerosis and atherosclerosis development in the aorta of apolipoprotein E knockout [Apo-E (-/-)] mice were evaluated in this study. Empagliflozin-treated mice had lower total cholesterol (P < 0.05), fasting glucose (P < 0.01), heart rate (P < 0.01) and diastolic blood pressure (DBP) (P < 0.05) compared to controls. Histomorphometry revealed reduced atherosclerotic lesion progress approaching statistical significance (P = 0.06) and approximately 50% wider lumen area for the Empagliflozin treated mice group. Although empagliflozin significantly reduced Vcam-1 and Mcp-1 (P < 0.05, P < 0.01, respectively) and marginally induced Timp-1 and Timp-2 mRNA expression (P < 0.08, P = 0.1 respectively), immunohistochemistry revealed a marginal reduction in VCAM-1 and MMP-9 (P = 0.1) without affecting the expression of TIMP-2 and MCP-1 in atherosclerotic lesions. Empagliflozin improves primary haemodynamic parameters and attenuates the progression of atherosclerosis by reducing hyperlipidemia and hyperglycemia, while direct actions in aorta vessel mediated via SGLT-1 are strongly hypothesized.
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MESH Headings
- Administration, Oral
- Animals
- Atherosclerosis/blood
- Atherosclerosis/drug therapy
- Atherosclerosis/pathology
- Atherosclerosis/physiopathology
- Benzhydryl Compounds/administration & dosage
- Benzhydryl Compounds/pharmacology
- Benzhydryl Compounds/therapeutic use
- Blood Glucose/metabolism
- Blood Pressure/drug effects
- Diastole/drug effects
- Diet, High-Fat
- Fasting/blood
- Glucosides/administration & dosage
- Glucosides/pharmacology
- Glucosides/therapeutic use
- Heart Rate/drug effects
- Hemodynamics/drug effects
- Lipids/blood
- Metalloproteases/metabolism
- Mice, Inbred C57BL
- Mice, Knockout, ApoE
- Plaque, Atherosclerotic/blood
- Plaque, Atherosclerotic/drug therapy
- Plaque, Atherosclerotic/pathology
- Plaque, Atherosclerotic/physiopathology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
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Affiliation(s)
- Georgios K Dimitriadis
- Division of Translational and Experimental Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; Division of Endocrinology and Experimental Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK; Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK; Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Narjes Nasiri-Ansari
- Department of Biological Chemistry, National and Kapodistrian Univer-sity of Athens Medical School, Athens, Greece
| | - Georgios Agrogiannis
- Laboratory of Pathological Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Manpal S Randeva
- Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Nikolaos Nikiteas
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vanlata H Patel
- Division of Translational and Experimental Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Gregory Kaltsas
- 1(st) Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, National and Kapodistrian Univer-sity of Athens Medical School, Athens, Greece
| | - Harpal S Randeva
- Division of Translational and Experimental Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK; Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, CV1 5FB, UK; Division of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eva Kassi
- Department of Biological Chemistry, National and Kapodistrian Univer-sity of Athens Medical School, Athens, Greece; 1(st) Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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25
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Moris D, Kostakis ID, Machairas N, Prodromidou A, Tsilimigras DI, Ravindra KV, Sudan DL, Knechtle SJ, Barbas AS. Comparison between liver transplantation and resection for hilar cholangiocarcinoma: A systematic review and meta-analysis. PLoS One 2019; 14:e0220527. [PMID: 31365594 PMCID: PMC6668826 DOI: 10.1371/journal.pone.0220527] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA. METHODS We systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$). RESULTS Neoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (p<0.00001). In contrast, no difference was found between the two treatment methods concerning postoperative mortality (p = 0.57). There was a trend towards longer overall survival after LT in comparison with resection. This was not obvious in the first year postoperatively, however, the advantage of LT over resection became obvious at 3 years after the operation (p = 0.02). CONCLUSIONS In non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA.
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Affiliation(s)
- Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Ioannis D. Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nikolaos Machairas
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Prodromidou
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I. Tsilimigras
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- * E-mail:
| | - Kadiyala V. Ravindra
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Debra L. Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Stuart J. Knechtle
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
| | - Andrew S. Barbas
- Department of Surgery, Duke University Medical Center, Durham, NC, United States of America
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Tsilimigras DI, Ntanasis-Stathopoulos I, Kostakis ID, Moris D, Schizas D, Cloyd JM, Pawlik TM. Is Resection of Primary Midgut Neuroendocrine Tumors in Patients with Unresectable Metastatic Liver Disease Justified? A Systematic Review and Meta-Analysis. J Gastrointest Surg 2019; 23:1044-1054. [PMID: 30671800 DOI: 10.1007/s11605-018-04094-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/28/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with midgut neuroendocrine tumors (MNETs) frequently present with metastatic disease at the time of diagnosis. Although combined resection of the primary MNET and liver metastases (NELM) is usually recommended for appropriate surgical candidates, primary tumor resection (PTR) in the setting of extensive, inoperable metastatic disease remains controversial. METHODS A systematic review was performed according to PRISMA guidelines utilizing Medline (PubMed), Embase, and Cochrane library-Cochrane Central Register of Controlled Trials (CENTRAL) databases until September 30, 2018. RESULTS Among patients with MNET and NELM, 1226 (68.4%; range, 35.5-85.1% per study) underwent PTR, whereas 567 (31.6%; range, 14.9-64.5%) patients did not. Median follow-up ranged from 55 to 90 months. Cytoreductive liver surgery was performed in approximately 15.7% (range, 0-34.8%) of patients. Pooled 5-year overall survival (OS) among the resected group was approximately 73.1% (range, 57-81%) versus 36.6% (range, 21-46%) for the non-resection group. For patients without liver debulking surgery, PTR remained associated with a decreased risk of death at 5 years compared with patients who did not have the primary tumor resected (HR 0.36, 95% CI 0.16 to 0.79, p = 0.01; I2 58%, p = 0.12). For patients undergoing PTR, 30-day postoperative mortality ranged from 1.43 to 2%. CONCLUSION PTR was safe with a low peri-operative risk of mortality and was associated with an improved OS for patients with MNET and unresectable NELM. Given the poor quality of evidence, however, strong evidenced-based recommendations cannot be made based on these retrospective single center-derived data. Future well-design randomized controlled trials will be critical in elucidating the optimal treatment strategies for patients with MNET and advanced metastatic disease.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | | | - Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Demetrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dimitrios Schizas
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Oncology, Health Services Management and Policy, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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27
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Machairas N, Papaconstantinou D, Tsilimigras DI, Moris D, Prodromidou A, Paspala A, Spartalis E, Kostakis ID. Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates Surg 2019; 71:39-48. [PMID: 30719624 DOI: 10.1007/s13304-019-00629-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Abstract
Minimally invasive liver surgery has evolved significantly during the last 2 decades. A growing number of published studies report outcomes from robotic liver resections (RLR). The aim of our meta-analysis was to evaluate short-term outcomes after RLR vs. open liver resection (OLR). A systematic search of Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases for articles published from January 2000 until November 2018 was performed. Ten non-randomized retrospective clinical studies comprising a total of 1248 patients were included in our meta-analysis. Four hundred and fifty-eight patients underwent RLR and 790 underwent OLR. RLRs were associated with lower overall morbidity rates (p =0.006) and shorter hospital stay (p <0.00001), whereas OLRs were associated with shorter operative time (p =0.003). No differences were shown between the two groups with regard to blood loss, blood transfusion requirements, R0 resection and mortality rates. Cumulative conversion rate was 4.6% in the RLR group. Due to limited available data, further prospective randomized studies are needed to better determine the potential beneficial role of the robotic approach in the treatment of malignant and benign hepatic tumors.
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Affiliation(s)
- Nikolaos Machairas
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece.
| | - Dimetrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Dimitrios Moris
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Anastasia Prodromidou
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Anna Paspala
- 3rd Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Ioannis D Kostakis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Feretis T, Kostakis ID, Damaskos C, Garmpis N, Mantas D, Nonni A, Kouraklis G, Dimitroulis D. Primary Hepatic Leiomyosarcoma: a Case Report and Review of the Literature. Acta Medica (Hradec Kralove) 2019; 61:153-157. [PMID: 30664449 DOI: 10.14712/18059694.2018.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Primary hepatic leiomyosarcoma is an extremely rare type of liver sarcoma with relatively poor prognosis, with about 50 cases having been reported in the literature. Potential origins of this tumor in the liver are the smooth muscle cells in the round ligament, intrahepatic blood vessels and intrahepatic bile ducts. There is no apparent sex predilection and there is a wide age range. The clinical presentation is not specific and the diagnosis depends on the expression of markers such as smooth muscle actin, desmin and vimentin by tumor cells. PATIENTS AND METHODS Herein, we present a case of a bulky primary hepatic leiomyosarcoma in a 68-year-old female patient. The patient underwent resection of the exophytic mass en block with the hepatic segments III and IVB. CONCLUSION Surgical resection is the most effective among the treatment options.
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Affiliation(s)
- Themistoklis Feretis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Afroditi Nonni
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Garoufalia Z, Prodromidou A, Machairas N, Kostakis ID, Stamopoulos P, Zavras N, Fouzas I, Sotiropoulos GC. Liver Transplantation for Wilson's Disease in Non-adult Patients: A Systematic Review. Transplant Proc 2019; 51:443-445. [PMID: 30879562 DOI: 10.1016/j.transproceed.2019.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Wilson's disease (WD) is a rare autosomal recessive disorder transmitted through a gene located on chromosome 13. Liver transplantation (LT) provides a therapeutic option for patients with WD presenting fulminant liver failure or drug resistance. LT in patients with WD has a twofold aim: to save the patient's life when the disorder has progressed to hepatic (or other organ) failure and to cure the underlying metabolic defect. The aim of our study was to investigate the indications, aspects and post-operative outcomes in pediatric patients (< 18 years old) with WD who underwent LT. METHODS A meticulous search of the literature since 1971 was performed. A retrospective analysis of all the studies, presenting cases of LT in children due to WD, was conducted. Studies that did not report patients' characteristics, transplantation indications, post-operative outcomes, and complications, as well as those with small study populations (< 10 patients), were excluded. RESULTS Six studies were included in the present review, which involved 290 children. The main indications for LT included chronic liver failure and fulminant liver failure. The average 1-year survival rate was 91.9%, while the average 5-year survival rate was 88.2%. Retransplantation was performed in 16 patients due to transplant rejection. In general, patients transplanted for WD displayed an excellent quality of life after LT. CONCLUSION LT is a safe and efficient procedure in selected pediatric patients with WD, demonstrating excellent long-term outcomes and quality of life.
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Affiliation(s)
- Z Garoufalia
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - A Prodromidou
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - N Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I D Kostakis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Stamopoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - N Zavras
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I Fouzas
- Division of Transplantation, Department of Surgery, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - G C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Prodromidou A, Machairas N, Garoufalia Z, Kostakis ID, Tsaparas P, Paspala A, Stamopoulos P, Sotiropoulos GC. Liver Transplantation for Giant Hepatic Hemangioma: A Systematic Review. Transplant Proc 2019; 51:440-442. [PMID: 30879561 DOI: 10.1016/j.transproceed.2019.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite their benign nature, liver hemangiomas (LH) are lesions that can cause major complications requiring intervention. Liver transplantation (LT) has been suggested as an effective treatment option in selected patients with giant LHs causing severe symptoms and cannot be treated otherwise. The aim of our study was to investigate the indications, aspects and post-operative outcomes of patients with a LH who underwent LT. MATERIALS AND METHODS A meticulous search of the literature was performed. Studies presenting cases of LT due to LH were evaluated. Studies presenting patients characteristics and symptoms, aspects of the disease, transplantation indications and details were selected. RESULTS Fifteen studies were included in the present review that involved 16 patients. Among them, 4 were male while the remaining 12 were female with a mean age of 39.9 ± 8.7 years. The main indications for LT included respiratory distress, massive hemorrhage, Kasabach-Merritt syndrome, and unsuccessful previous treatment strategies. Four patients were transplanted from living donors and the remaining 12 from cadaveric donors. No post-operative deaths were reported and all patients returned to normal activity. No deaths during the long-term follow-up were reported. CONCLUSIONS LH is an extremely rare indication for LT. Nevertheless, the currently available data suggest that LT is a safe and efficient treatment in the management of symptomatic or complicated LH in selected patients.
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Affiliation(s)
- A Prodromidou
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - N Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Z Garoufalia
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I D Kostakis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Tsaparas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Paspala
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Stamopoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Kostakis ID, Sikalias N, Alexiou K, Mountzalia L, Papalois A, Karatzas T. How Much Ischemia Can the Severely Steatotic Rat Liver Tolerate? In Vivo 2018; 32:1381-1386. [PMID: 30348692 DOI: 10.21873/invivo.11390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
Abstract
AIM Steatotic liver is more susceptible to ischemia-reperfusion injury than is lean liver. Our aim was to investigate the ability of the severely steatotic rat liver to sustain ischemia. MATERIALS AND METHODS One hundred male Wistar rats aged 12-14 weeks were included. Fifty rats were given regular diet, while the rest were given a choline-free diet for 12-14 weeks to develop severe liver steatosis. Each group was divided into the following five subgroups: Sham-operated, and 5, 10, 15 and 20 minutes of continuous vascular inflow occlusion. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels were measured at 24 hours postoperatively and the animals were surveilled for 30 days. RESULTS Serum transaminase levels increased as the duration of ischemia increased in lean livers (p<0.0001), without a significant impact on animal survival. Similarly, serum transaminase levels increased as the duration of ischemia increased in severely steatotic livers (p<0.0001), reaching a plateau after 15 minutes of liver ischemia. Survival was significantly affected after the same cut-off point in rats with steatotic liver (p<0.0001). Serum transaminase levels were greater in severely rats with steatotic liver than in rats with lean liver, when they were adjusted for the duration of liver ischemia. Moreover, survival was reduced when serum transaminase levels surpassed the threshold of 2,000 IU/l (p<0.0001). CONCLUSION Severely steatotic rat liver can safely tolerate up to 10 minutes of continuous ischemia, with survival being affected after 15 minutes or more. On the other hand, lean rat liver can safely tolerate even 20 minutes of continuous ischemia.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Sikalias
- Department of Surgery, Sismanogleion General Hospital, Athens, Greece
| | | | | | | | - Theodore Karatzas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Kostakis ID, Machairas N, Prodromidou A, Garoufalia Z, Charalampoudis P, Sotiropoulos GC. Microbe Isolation from Blood, Central Venous Catheters, and Fluid Collections after Liver Resections. Surg Infect (Larchmt) 2018; 20:49-54. [PMID: 30300569 DOI: 10.1089/sur.2018.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our goal was to evaluate the microbe species responsible for bacteremia or infections related to central venous catheter (CVC) or fluid collections after liver resection. PATIENTS AND METHODS Data from 112 patients (68 males, 44 females) who underwent liver resection over a period of 63 months were reviewed. Patient and tumor characteristics, intra-operative and post-operative data, and the results from cultures of peripheral blood, CVC tips and drained intra-abdominal or intra-throracic fluid collections were collected. RESULTS There were positive blood cultures in 20 patients (17.9%). Coagulase-negative staphylococci (CoNS) and bacteria of enteric flora were the micro-organisms found most frequently and half of the cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis was an independent risk factor for microbe isolation in peripheral blood (odds ratio [OR]: 11, p = 0.01). Furthermore, there were positive cultures of the CVC tip in 14 patients (12.5%), with CoNS being the micro-organism found most frequently and most cases had only one isolated microbe species. No specific risk factor for catheter-related infections was detected. In addition, there were positive cultures of drained fluid collections in 19 patients (17%), with bacteria of enteric flora being the micro-organisms found most frequently and the majority of cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis (OR: 23.5, p = 0.002) and the laparoscopic approach (OR: 4.7, p = 0.0496) were independent risk factors for microbe isolation in drained fluid collections. Finally, the presence of positive blood cultures was associated with the presence of positive culture of CVC tips (p = 0.018) and drained fluid collections (p = 0.001). CONCLUSIONS Post-operative bacteremia, colonization of CVCs, and contamination of fluid collections occur frequently after liver resections and various microbe species may be involved. Patients who undergo hepatectomy and a synchronous construction of a bilioenteric anastomosis are at increased risk of bacteremia development and contamination of fluid collections.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Petros Charalampoudis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens , Medical School, Athens, Greece
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Garoufalia Z, Machairas N, Kostakis ID, Zormpala A, Kouraklis G, Dimitroulis D. A seemingly innocent wound in an octogenarian. Surgery 2018; 164:1388-1389. [PMID: 30154019 DOI: 10.1016/j.surg.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Greece.
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Greece
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Gregory Kouraklis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Greece
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Nasiri-Ansari Ν, Dimitriadis GK, Agrogiannis G, Perrea D, Kostakis ID, Kaltsas G, Papavassiliou AG, Randeva HS, Kassi E. Canagliflozin attenuates the progression of atherosclerosis and inflammation process in APOE knockout mice. Cardiovasc Diabetol 2018; 17:106. [PMID: 30049285 PMCID: PMC6063004 DOI: 10.1186/s12933-018-0749-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Sodium glucose co-transporter2 inhibitors reduce the incidence of cardiovascular events in patients with type 2 diabetes mellitus based on the results of recent cardiovascular outcome studies. Herein, we investigated the effects of long-term treatment with canagliflozin on biochemical and immunohistochemical markers related to atherosclerosis and atherosclerosis development in the aorta of apolipoprotein E knockout (Apo-E(−/−)) mice. Methods At the age of 5 weeks, mice were switched from normal to a high-fat diet. After 5 weeks, Apo-E(−/−) mice were divided into control-group (6 mice) treated with 0.5% hydroxypropyl methylcellulose and Cana-group (7 mice) treated with canagliflozin (10 mg/kg per day) per os. After 5 weeks of intervention, animals were sacrificed, and heart and aorta were removed. Sections stained with hematoxylin–eosin (H&E) were used for histomorphometry whereas Masson’s stained tissues were used to quantify the collagen content. Immunohistochemistry to assess MCP-1, CD68, a-smooth muscle actin, MMP-2, MMP-9, TIMP-1 and TIMP-2 expression was carried out and q-PCR experiments were performed to quantify mRNA expression. Results Canagliflozin-group mice had lower total-cholesterol, triglycerides and glucose levels (P < 0.01), while heart rate was significantly lower (P < 0.05). Histomorphometry revealed that one in seven Cana-group mice versus four in six control mice developed atheromatosis, while aortic root plaque was significantly less, and collagen was 1.6 times more intense in canagliflozin-group suggesting increased plaque stability. Immunohistochemistry revealed that MCP-1 was significantly less expressed (P < 0.05) in the aortic root of canagliflozin-group while reduced expression of a-actin and CD68 was not reaching significance (P = 0.15). VCAM-1 and MCP-1 mRNA levels were lower (P = 0.02 and P = 0.07, respectively), while TIMP-1/MMP-2 ratio expression was higher in canagliflozin-group approaching statistical significance (P = 0.07). Conclusions Canagliflozin attenuates the progression of atherosclerosis, reducing (1) hyperlipidemia and hyperglycemia, and (2) inflammatory process, by lowering the expression of inflammatory molecules such as MCP-1 and VCAM-1. Moreover, canagliflozin was found to increase the atherosclerotic plaque stability via increasing TIMP-1/MMP-2 ratio expression. Electronic supplementary material The online version of this article (10.1186/s12933-018-0749-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Νarjes Nasiri-Ansari
- Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios K Dimitriadis
- Division of Translational and Experimental Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Division of Endocrinology and Experimental Medicine, Imperial College London, Hammersmith Campus, London, UK.,Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Georgios Agrogiannis
- Laboratory of Pathological Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Gregory Kaltsas
- Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Harpal S Randeva
- Division of Translational and Experimental Medicine-Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. .,Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK. .,Division of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eva Kassi
- Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece. .,First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Moris D, Tsilimigras DI, Kostakis ID, Ntanasis-Stathopoulos I, Shah KN, Felekouras E, Pawlik TM. Anatomic versus non-anatomic resection for hepatocellular carcinoma: A systematic review and meta-analysis. Eur J Surg Oncol 2018; 44:927-938. [DOI: 10.1016/j.ejso.2018.04.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/30/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
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Kostakis ID, Machairas N, Garoufalia Z, Prodromidou A, Sotiropoulos GC. Impact of Ultrasonic Scalpels for Liver Parenchymal Transection on Postoperative Bleeding and Bile Leakage. In Vivo 2018; 32:883-886. [PMID: 29936474 DOI: 10.21873/invivo.11323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Novel techniques for liver parenchymal transection have emerged and they are available to the hepatobiliary surgeon. The aim of our study was to compare two types of ultrasonic scalpels (Lotus and Harmonic) and examine how they perform either alone or in combination with the SonaStar ultrasonic surgical aspiration system regarding postoperative bleeding and bile leakage. PATIENTS AND METHODS Our prospectively maintained database of patients who underwent liver resections in our Department was reviewed. One hundred and two patients with solid liver lesions underwent liver resection by a senior hepatobiliary surgeon in our department during a period of 51 months. They were divided into four groups according to the devices that were used for liver parenchymal transection. RESULTS Patients were divided into the following groups: group 1: Lotus, 32 patients (31.4%); group 2: Lotus+SonaStar, 27 patients (26.5%); group 3: Harmonic, 27 patients (26.5%); group 4: Harmonic+SonaStar, 16 patients (15.7%). There were 5 cases of postoperative bleeding and 9 cases of postoperative bile leakage. No significant difference was found concerning postoperative bleeding (group 1: 2/32; 6.3%, group 2: 2/27; 7.4%, group 3: 0/27; 0%, group 4: 1/16; 6.3%) (p=0.577). Furthermore, no actual difference was detected in terms of postoperative bile leakage (group 1: 2/32; 6.3%, group 2: 3/27; 11.1%, group 3: 3/27; 11.1%, group 4: 1/16; 6.3%) (p=0.866). CONCLUSION Both Lotus and Harmonic ultrasonic scalpels provide adequate and similar results concerning postoperative hemorrhage and cholorrhea.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Garoufalia Z, Machairas N, Kostakis ID, Liakea A, Tsaparas P, Liapis G, Sotiropoulos GC. Malignant potential of epithelioid angiomyolipomas of the liver: A case report and comprehensive review of the literature. Mol Clin Oncol 2018; 9:226-230. [PMID: 30101028 DOI: 10.3892/mco.2018.1659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Hepatic epithelioid angiomyolipoma (HEAML) is a rare mesenchymal tumor that has been reported to have malignant potential. We herein describe a rare case of atypical HEAML. A 43-year-old Caucasian male patient visited his general practitioner due to a productive cough persisting for >2 months. During evaluation with several imaging tests, a chest computed tomography (CT) incidentally revealed a well-demarcated lesion in the caudate lobe of the liver, sized 7 cm. An abdominal magnetic resonance imaging examination confirmed the findings of the CT. The possibility of hepatocellular carcinoma at that time could not be excluded. Due to inconclusive cross-sectional imaging, the patient underwent left hepatectomy with additional resection of segment I. The patient's postoperative course was uneventful. A diagnosis of 'atypical' HEAML was established in the present case. The majority of HEAMLs are considered to be benign, although there are several reported cases exhibiting malignant behavior, such as tumor growth, presence of atypical cells, recurrence after surgical resection, metastasis and invasive growth into the liver parenchyma and alongside the vessels. From 2000 onwards, 19 cases of malignant hepatic AML have been reported. Malignant transformation is considered to occur mostly in the epithelioid subtype. To that end, when epithelioid or atypical characteristics are identified on preoperative biopsy, resection is indicated due to the high probability of malignancy.
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Affiliation(s)
- Zoe Garoufalia
- Second Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece
| | - Aliki Liakea
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Tsaparas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece
| | - George Liapis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Paspala A, Machairas N, Prodromidou A, Spartalis E, Ioannidis A, Kostakis ID, Papaconstantinou D, Nikiteas N. Management of MANEC of the colon and rectum: A comprehensive review of the literature. Mol Clin Oncol 2018; 9:219-222. [PMID: 30101026 DOI: 10.3892/mco.2018.1649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022] Open
Abstract
Mixed adeno-neuroendocrine carcinoma (MANEC) is a rare pathological diagnosis recently acknowledged by the World Health Organization in 2010. MANEC is a neoplasm characterized by significant histological heterogeneity and is characterized by the simultaneous presence of both adenocarcinomatous and neuroendocrine differentiation; their definition includes each component found in at least 30% of the tumor. Colorectal MANEC constitutes an uncommon type of malignant tumor. The true prevalence of colorectal MANEC has not been precisely defined and published studies are limited to case reports and small case series. The aim of the present review was to accumulate the existing evidence on colorectal MANEC with special attention to the clinicopathological characteristics, management and survival rates of patients diagnosed with this malignancy. A total of 20 studies (16 case reports and 4 retrospective cohorts) reported outcomes for patients with colorectal MANEC and were finally considered eligible for analysis. The results of the present study show that patients with early stage MANEC have more favorable survival compared to those diagnosed in advanced stages. Due to its neuroendocrine nature, which is characterized by rapid progression, MANEC is diagnosed in advanced stages in the majority of cases and thus potentially explains the poor survival rates. Because of its aggressive nature and high recurrence rate, adjuvant chemotherapy constitutes a critical part of the treatment and significantly improves survival. Further larger studies are needed in order to establish guidelines for the treatment of these rare lesions.
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Affiliation(s)
- Anna Paspala
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Machairas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Prodromidou
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Argyrios Ioannidis
- Second Department of General Surgery, 'Sismanoglio' General Hospital, 15126 Athens, Greece
| | - Ioannis D Kostakis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimetrios Papaconstantinou
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Prodromidou A, Pavlakis K, Pergialiotis V, Frountzas M, Machairas N, Kostakis ID, Korou LM, Stergios K, Dimitroulis D, Vaos G, Perrea DN. Healing after Resection of Colonic Endometriosis and Growth Factor-enriched Agents: An Experimental Rat Model. J Minim Invasive Gynecol 2018; 26:463-470. [PMID: 29890349 DOI: 10.1016/j.jmig.2018.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To examine the potential beneficial effect of platelet-rich plasma (PRP) and fibrin sealant (TISSEEL; Baxter Healthcare Corporation, Deerfield, IL) on bowel wound healing after shaving of an experimentally induced endometriotic lesion. DESIGN A single-blind, randomized study (Canadian Task Force classification I). SETTING A certified animal research facility. ANIMALS Thirty female Sprague-Dawley rats. INTERVENTIONS Experimental colonic endometriosis was induced by transplanting endometrial tissue to all animals (first surgery). Thirty rats were then randomized to 1 of 3 groups according to treatment; PRP (group 1, n = 10), fibrin sealant (group 2, n = 10), or no agent (group 3, n = 10) was applied after shaving of the endometriotic nodule (second surgery). MEASUREMENTS AND MAIN RESULTS Colonic endometriosis was successfully induced in all subjects. Four days after the second surgery, the animals were euthanized, and microscopic evaluation was performed. The pathologist was blinded to the treatment method. Histopathologic analysis revealed that compared with the control group, collagen disposition was found in a significantly higher expression in both the PRP and fibrin sealant groups (p = .011 and p = .011, respectively). Distortion of the integrity of the colon layers was statistically more pronounced in the control group compared with the fibrin sealant group (p = .033), whereas greater new blood vessel formation was observed in the fibrin sealant group compared with the control (p = .023). No histologic evidence of residual or recurrent disease was detected. CONCLUSION Both PRP and fibrin sealant appear to be safe and associated with improved tissue healing during shaving for the excision of colonic endometriosis, attributed to the enhanced collagen disposition, neovascularization, and protection of the integrity of colon layers. Clinical trials are warranted to confirm the feasibility of PRP and fibrin sealant in the clinical setting.
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Affiliation(s)
- Anastasia Prodromidou
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos).
| | - Kitty Pavlakis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Vasileios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Nikolaos Machairas
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Ioannis D Kostakis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Laskarina M Korou
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Dimitrios Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - George Vaos
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
| | - Despoina N Perrea
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas" (Drs. Prodromidou, Pergialiotis, Frountzas, Korou, Stergios, Vaos, and Perrea), Department of Pathology (Dr. Pavlakis), Third Department of Surgery, Attiko University Hospital (Dr. Machairas), Second Department of Surgery, Laiko University Hospital(,) (Drs. Kostakis and Dimitroulis), and Department of Paediatric Surgery, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Dr. Vaos)
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Matthaiou S, Kostakis ID, Kykalos S, Machairas N, Spartalis E, Ntikoudi E, Lambropoulou M, Karayiannakis A, Machairas N. KISS1 and KISS1R expression in primary and metastatic colorectal cancer. J BUON 2018; 23:598-603. [PMID: 30003725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Kisspeptins are produced by the KISS1 gene and have tumor-suppressing and anti-metastatic properties. Our aim was to study the expression of KISS1 and its receptor, KISS1R, in colorectal cancer. METHODS KISS1 and KISS1R expression was detected using immunohistochemistry in malignant tissue samples from 66 patients (34 men, 32 women) with colorectal adenocarcinoma. In total, 74 tumor samples were studied, 57 samples from primary tumors and 17 samples from liver metastases. KISS1 and KISS1R levels were associated with various clinicopathological parameters and survival data. RESULTS KISS1 expression was higher in primary tumors with advanced stage (III or IV) and in those with infiltrated lymph nodes. KISS1R expression was higher in primary tumors with distant metastases. No significant differences were detected between primary and metastatic tumors regarding KISS1 and KISS1R levels. Furthermore, patients with high KISS1R levels had longer overall survival. CONCLUSIONS KISS1 and KISS1R expression is higher in advanced colorectal cancers and high KISS1R levels are associated with better prognosis in colorectal cancer.
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Affiliation(s)
- Spyridon Matthaiou
- Second Department of Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
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Machairas N, Papaconstantinou D, Stamopoulos P, Prodromidou A, Garoufalia Z, Spartalis E, Kostakis ID, Sotiropoulos GC. The Emerging Role of Laparoscopic Liver Resection in the Treatment of Recurrent Hepatocellular Carcinoma: A Systematic Review. Anticancer Res 2018; 38:3181-3186. [PMID: 29715160 DOI: 10.21873/anticanres.12582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Tumor recurrence complicates more than half of patients at 5 years after primary hepatocellular carcinoma (HCC) resection. Repeat open liver resection (ROLR) is the standard procedure for patients eligible for repeat resection, whereas laparoscopic repeat liver resection (RLLR) has been proposed as an alternative approach. The aim of this systematic review is to evaluate studies reporting on outcomes of RLLR for recurrent HCC (rHCC). MATERIALS AND METHODS A comprehensive search of the literature was undertaken. RESULTS A total of 11 studies, 6 non-comparative and 5 comparative (RLLR versus ROLR), which reported outcomes for 165 patients who underwent RLLR, were included in our review. RLLRs were associated with reduced blood loss, shorter hospital stay, lower conversion to ROLR and lower morbidity rates. CONCLUSION Selected patients with rHCC who undergo RLLR, benefit in terms of short-term outcomes. Larger prospective trials will elucidate the impact of RLLR on long-term outcomes and establish treatment guidelines.
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Affiliation(s)
- Nikolaos Machairas
- Third Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- Third Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Stamopoulos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tsoukalas N, Kiakou M, Tolia M, Kostakis ID, Galanopoulos M, Nakos G, Tryfonopoulos D, Kyrgias G, Koumakis G. Mucinous breast carcinoma with tall columnar cells. Ann R Coll Surg Engl 2018; 100:e132-e135. [PMID: 29658333 DOI: 10.1308/rcsann.2018.0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mucinous carcinoma of the breast represents 1%-4% of all breast cancers. The World Health Organization classification divides this type of tumour into three different subtypes: mucinous carcinoma, mucinous carcinoma with tall columnar cells (mucinous cystadenocarcinoma and columnar cell mucinous carcinoma) and signet ring cell carcinoma. A 74-year-old woman presented a tumour with inflammatory features in the upper outer quadrant of her left breast, 7 cm in diameter. The core biopsy showed infiltrating ductal carcinoma of no specific type. The tumour-node-metastasis clinical staging was T4cN3M0 (Stage IIIC). She received neoadjuvant chemotherapy, underwent left mastectomy with radical axillary resection and subsequently received radiotherapy and chemotherapy. The histological examination of the surgical specimen revealed two solid tumors in the tail of Spence, which corresponded to adenocarcinoma with high columnar cells. The patient died 16 months after the diagnosis, suffering from pulmonary metastases and anterior chest wall infiltration. A review of the literature revealed only 21 reports of mucinous carcinoma of the breast with tall columnar cells, including our case. This is only the third time that the specific histological type of columnar cell mucinous carcinoma has been reported in the literature.
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Affiliation(s)
- N Tsoukalas
- Department of Oncology, 401 General Military Hospital , Athens , Greece.,Second Department of Medical Oncology, Agios Savvas Anticancer Hospital , Athens , Greece.,Contributed equally
| | - M Kiakou
- Department of Oncology, 401 General Military Hospital , Athens , Greece.,Contributed equally
| | - M Tolia
- Department of Radiotherapy, University of Thessaly, Medical School , Larissa , Greece
| | - I D Kostakis
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - M Galanopoulos
- Department of Oncology, 401 General Military Hospital , Athens , Greece
| | - G Nakos
- Department of Pathology, 401 General Military Hospital , Athens , Greece
| | - D Tryfonopoulos
- Second Department of Medical Oncology, Agios Savvas Anticancer Hospital , Athens , Greece
| | - G Kyrgias
- Department of Radiotherapy, University of Thessaly, Medical School , Larissa , Greece
| | - G Koumakis
- Second Department of Medical Oncology, Agios Savvas Anticancer Hospital , Athens , Greece
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Prodromidou A, Machairas N, Kostakis ID, Molmenti E, Spartalis E, Kakkos A, Lainas GT, Sotiropoulos GC. Outcomes after open and laparoscopic appendectomy during pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:40-50. [PMID: 29656140 DOI: 10.1016/j.ejogrb.2018.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/06/2018] [Accepted: 04/08/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Acute appendicitis is the most prevalent cause of non-obstetrical surgical disease during pregnancy. There is no consensus on the optimal surgical management of acute appendicitis in pregnancy. Our aim is to identify surgical and obstetrical outcomes of laparoscopic (LA) and open approach (OA) in pregnant patients with acute appendicitis. STUDY DESIGN Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases were searched for articles published up to May 2017, along with the references of all articles. Prospective and retrospective trials reporting outcomes among pregnant women undergoing laparoscopic and open appendectomy were included. Of the 493 records screened, 20 were eligible for meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Statistical meta-analysis was performed using the RevMan 5.3 software. RESULTS A total of 6210 pregnant women from twenty studies were included in meta-analysis. Laparoscopic appendectomy was associated with significantly lower overall complication rates and shorter hospital stays (1835 patients OR 0.48 95% CI 0.29, 0.80 p = 0.005). While the open appendectomy group showed prolongation of gestational age for term deliveries, laparoscopic appendectomy patients had higher rates of fetal loss (543 patients MD -0.46 weeks 95% CI-0.87 to -0.04, p = 0.03 and 4867 patients OR 1.82 95% CI 1.30 to 2.57, p = 0.0006, respectively). CONCLUSIONS Current literature remains inconclusive on the optimal approach of appendectomy in pregnant women. Further larger-volume studies are needed in order to elucidate the critical effect of laparoscopic appendectomy on fetal loss rates.
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Affiliation(s)
- Anastasia Prodromidou
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Ernesto Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Eleftherios Spartalis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athanasios Kakkos
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | | | - Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Sotiropoulos GC, Machairas N, Kostakis ID, Stamopoulos P, Charalampoudis P, Kykalos S, Kouraklis G, Mantas D. Early Experience in Starting a Laparoscopic Liver Resection Program in Greece. JSLS 2018; 21:JSLS.2016.00110. [PMID: 28701858 PMCID: PMC5506778 DOI: 10.4293/jsls.2016.00110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: Laparoscopic liver resections (LLRs) have gained wider acceptance during the decade as safe and efficient procedures in the management of several benign and malignant diseases when performed by experienced surgeons. We report our initial institutional experience with LLRs performed by 1 certified hepatobiliary surgeon. Methods: Patients undergoing LLRs by 1 senior hepatobiliary surgeon in our Institution during the period from January 2012 through January 2017 were prospectively sampled and retrospectively analyzed for the purposes of this study. Results: Forty-two of 175 patients (24%) who had surgery for liver tumors underwent LLR. Median age was 64 years; median body mass index and Charlson comorbidity index were 27.3 kg/m2 and 6.5, respectively. Patients underwent resections for benign (n = 22) or malignant (n = 20) lesions. Median total operating time was 115 minutes and liver resections included: 1 left hepatectomy, 11 bisegmentectomies, 7 segmentectomies, 5 wide wedge resections, 1 left lateral sectionectomy combined with segmentectomy and radiofrequency ablation, 15 liver cyst unroofing, 1 laparoscopic drainage of a pyogenic liver abscess, and 1 laparoscopic drainage of a hepatic hydatid cyst. Blood transfusion was needed in 10 patients. Six patients (14%) had postoperative complications, none of which necessitated reoperation. None of the patients was admitted to the intensive care unit after surgery, and the median hospital stay was 4 days. The tumor-free resection margin was documented in all primary or secondary oncologic cases. Conclusions: Careful patient selection and compliance with the international recommendations are the keys for the successful introduction and evolution of an LLR program with a certified hepatobiliary surgeon with laparoscopic experience.
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Affiliation(s)
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | | | | | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, General Hospital Laiko, Athens, Greece
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Karaolanis G, Kostakis ID, Moris D, Palla VV, Moulakakis KG. Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review. Int J Angiol 2018; 27:13-22. [PMID: 29483761 DOI: 10.1055/s-0037-1620241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. Methods The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. Results We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. Conclusions SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.
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Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Demetrios Moris
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Viktoria-Varvara Palla
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Abstract
Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status.
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Affiliation(s)
- Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Sotiropoulos GC, Machairas N, Kostakis ID. Case Report: Laparoscopic hepatectomy in an elderly patient with major comorbidities. F1000Res 2018; 6:1286. [PMID: 29333234 PMCID: PMC5747337 DOI: 10.12688/f1000research.12078.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 11/20/2022] Open
Abstract
Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status.
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Affiliation(s)
- Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Kostakis ID, Agrogiannis G, Vaiopoulos AG, Mylona E, Patsouris E, Kouraklis G, Koutsilieris M. KISS1 and KISS1R expression in gastric cancer. J BUON 2018; 23:79-84. [PMID: 29552764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Kisspeptins, which are derived from the gene KISS1, supress tumor progression. We intended to investigate the production of KISS1 and its receptor (KISSR) in gastric cancer. METHODS The expression of KISS1 and KISS1R in both normal and cancer tissue was examined with immunohistochemistry in tissue specimens of 40 cases of gastric adenocarcinoma. RESULTS KISS1 expression in normal gastric mucosa was much higher than in malignant mucosa. KISS1 expression was higher in early stages (stage I or II) than in advanced stages (stage III or IV), in tumors with intestinal histological type than in those with diffuse histological type, in tumors without lymphovascular invasion than in those with and in cancers of older patients (≥70 years) than in younger patients. No significant differences were found regarding other clinicopathological parameters. There was no KISS1R expression in cancer tissues, while only low levels of KISS1R were detected in normal gastric epithelium. CONCLUSIONS KISS1 expression is decreased during carcinogenesis in gastric mucosa. More advanced tumors and more aggressive histological types produce lower KISS1 levels. In addition, no KISS1R is produced in malignant gastric epithelium, while KISS1R is only weakly expressed in normal gastric epithelium.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Machairas N, Prodromidou A, Molmenti E, Kostakis ID, Sotiropoulos GC. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol 2017; 8:1100-1108. [PMID: 29299371 DOI: 10.21037/jgo.2017.08.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The recommended management of liver metastases (LM) from gastrointestinal stromal tumors (GISTs) disease consists of perioperative administration of tyrosine kinase inhibitors (TKIs) and surgical resection. The aim of our study was to investigate the efficacy of this therapeutic approach. Studies reporting outcomes for patients underwent liver resection from metastatic gastrointestinal stromal tumor (GIST) were overviewed. Eleven studies were included, which enrolled 240 patients with liver metastasis from GISTs. A median overall survival (OS) interval of 41.8 months was calculated while a median disease free interval of 17.9 [17-43] months following resection was also measured. Recurrences were recorded in 63 patients. Prognostic factors identified by the studies included surgical resection, R0 resection, age <55 years, clinical response to TKIs, pre- and postoperative administration of TKIs. The included studies highlight the importance of complete resection and the timing of resection, as well underline the importance of pre- and post-operative administration of TKIs.
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Affiliation(s)
- Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ernesto Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Tsoukalas N, Kostakis ID, Giaginis C, Tolia M, Galanopoulos M, Kiakou M, Aravantinou-Fatorou E, Tsapakidis K, Baxevanos P, Litos I, Tzouda V, Tzovaras A, Kyrgias G, Tsiambas E, Theocharis S. Carcinoembryonic antigen and carbohydrate antigen 19-9 serum levels in non-small cell lung cancer. J BUON 2017; 22:1390-1394. [PMID: 29332328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Τo investigate the potential diagnostic and prognostic role of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) serum levels in non-small cell lung cancer (NSCLC). METHODS One hundred consecutive patients with newly diagnosed primary NSCLC were included in this study (88 men and 12 women). Blood was drawn before any kind of treatment and the collected serum was processed using chemiluminescence in order CEA and CA 19-9 levels to be measured. RESULTS No significant associations between CEA or CA 19-9 levels and any tested clinical and pathological parameter were detected. Moreover, CEA levels did not seem to affect survival. On the other hand, patients with high CA 19-9 values (≥37 IU/ml) (median survival: 8 months) had a shorter overall survival than patients with low CA 19-9 values (<37 IU/ml) (median survival: 13 months) (p=0.026). However, CA 19-9 levels did not remain an independent prognostic factor in the multivariate survival analysis (p=0.114). CONCLUSION CEA and CA 19-9 serum levels do not seem to have any diagnostic role in NSCLC. With regard to their prognostic role, CEA values do not seem to affect the prognosis in NSCLC. However, high CA 19-9 values are associated with worse prognosis.
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