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Radiofrequency ablation-assisted liver resection a step toward bloodless liver resection

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 69-74页

作者： Athanasios Petrou Kyriakos Neofytou Constantinos Mihas Jessamy Bagenal Michael Kontos John Griniatsos evangelos felekouras Nicosia Surgical Department Division of Hepatobiliary Pancreatic Surgery Nicosia General Hospital First Department of Surgery University of Athens Medical School LAIKO Teaching Hospital Bristol Heart Institute Severn School of Surgery

BACKGROUND： Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofrequency ablation is used more often for liver parenchymal transection. This study aimed to assess the efficacy and safety of radiofrequency ablation-assisted liver ***： A retrospective study of 145 consecutive patients who underwent radiofrequency ablation-assisted liver resection was performed. Intraoperative blood loss, need for transfusion or intraoperative Pringle maneuver, the duration of liver parenchymal transection, perioperative complications, and postoperative morbidity and mortality were all ***： Fifty minor and ninety-five major liver resections were performed. The mean intraoperative blood loss was 251 m L, with a transfusion rate of 11.7%. The Pringle maneuver was necessary in 12 patients（8.3%）. The mean duration for parenchymal transection was 51.75 minutes. There were 47 patients（32.4%） with postoperative complications. There is no mortality within 30 days after surgery. CONCLUSIONS： Radiofrequency ablation-assisted liver resection permits both major and minor liver resections with minimal blood loss and without occlusion of hepatic inflow. Furthermore it decreases the need for blood transfusion and reduces morbidity and mortality.

关键词： bleeding complications hepatectomy radiofrequency ablation Pringle maneuver

Malignant carcinoid tumor of the cystic duct:a rare cause of bile duct obstruction

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 640-646页

作者： evangelos felekouras Athanasios Petrou Konstantinos Bramis evangelos Prassas Ioannis Papaconstantinou Nikoleta Dimitriou Anastasia Pazaiti Christos Tsigris Athanasios Giannopoulos First Department of Surgery National and Kapodistrian University of AthensMedical SchoolLAIKON General Hospital

BACKGROUND:Carcinoid tumors of the extrahepatic biliary tree are extremely rare malignancies,accounting for 0.2%-2%of all gastrointestinal carcinoid tumors,while carcinoids of the cystic duct are an uncommon entity and an extremely unusual cause of bile duct ***:After an extensive literature review,we retrospectively analysed 61 cases of carcinoid tumor of the biliary tree as well as one additional case of a 60-yearold female with symptoms and laboratory/imaging examination findings compatible with those of a malignant biliary tract *** laparotomy,resection of the gallbladder and common bile duct was *** study revealed a well-differentiated neuroendocrine carcinoma of the cystic *** patient remained disease-free at 16 ***:Our presentation is the seventh case reported in the world *** to cholangiocarcinoma,analysis of the reviewed group indicates an increased incidence of extrahepatic carcinoid tumors in younger persons along with a slight female ***,the most common anatomic location is the common bile duct,followed by the perihilar region and the cystic *** is the most common *** surgery was realized in the majority of cases and longterm disease-free survival was achieved when surgery was ***:Carcinoid tumors obstructing the biliary tree are extremely difficult to diagnose preoperatively,and nearly impossible to differentiate from non-neuroendocrine *** surgery offers the only potential cure for both biliary carcinoids and cholangiocarcinoma,we recommend aggressive surgical therapy as the treatment of choice in every case of potentially resectable biliary tumor.

关键词： carcinoid tumor biliary tree cystic duct well-differentiated endocrine tumor

Combined hepatocellular-cholangiocarcinoma:An update on epidemiology,classification,diagnosis and management

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Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 515-523页

作者： Dimitrios Schizas Aikaterini Mastoraki Eleni Routsi Michail Papapanou Dimitrios Tsapralis Pantelis Vassiliu Konstantinos Toutouzas evangelos felekouras First Department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthensGreece Fourth Department of Surgery National and Kapodistrian University of AthensAttikon University HospitalAthensGreece Surgical Department General Hospital of IerapetraIerapetraGreece First Department of Propaedeutic Surgery National and Kapodistrian University of AthensHippocration HospitalAthensGreece

Background:Combined hepatocellular-cholangiocarcinoma(CHC)is a rare subtype of primary hepatic malignancies,with variably reported incidence between 0.4%–14.2%of primary liver cancer *** study aimed to systematically review the epidemiological,clinicopathological,diagnostic and therapeutic data for this rare *** sources:We reviewed the literature of diagnostic approach of CHC with special reference to its clinical,molecular and histopathological *** analysis of the recent literature in order to evaluate the results of surgical and systemic treatment of this entity has been ***:The median age at CHC’s diagnosis appears to be between 50 and 75 *** of tumor markers[alpha fetoprotein(AFP),carbohydrate antigen 19–9(CA19–9)and carcinoembryonic antigen(CEA)]along with imaging patterns provides better opportunities for CHC’s preoperative *** clinicopathologic prognostic parameters possibly correlated with increased tumor recurrence and grimmer survival odds include advanced age,tumor size,nodal and distal metastases,vascular and regional organ invasion,multifocality,decreased capsule formation,stem-cell features verification and increased GGT as well as CA19–9 and CEA *** case of inoperable or recurrent disease,combinations of cholangiocarcinoma-directed systemic agents display superior results over ***-directed methods,such as transarterial chemoembolization(TACE),percutaneous ethanol injection(PEI),hepatic arterial infusion chemotherapy(HAIC),radioembolization and ablative therapies,demonstrate inferior efficacy than in cases of hepatocellular carcinoma(HCC)due to CHC’s common ***:CHC demonstrates an overlapping clinical and biological pattern between its malignant *** history of the disease seems to be determined by the predominant tumor *** standard for diagnosis is histology of surgical *** therapeutic int

关键词： Combined hepatocellular-cholangiocarcinoma Classification Diagnostic approach Therapeutic management

Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly:A study of 33 cases

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World Journal of Gastroenterology 2007年第6期13卷 921-924页

作者： Michael Safioleas Constantinos Chatziconstantinou evangelos felekouras Michael Stamatakos Ioannis Papaconstantinou Anastasios Smirnis Panagiotis Safioleas Alkiviades Kostakis 2~(nd) Department of Propedeutic Surgery School of Medicine Athens University Laiko Hospital Greece Department of Radiology Laiko Hospital Athens Greece 1~(st) Department of Surgery School of Medicine Athens University Laiko Hospital Greece

AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteristics of 33 sigrnoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS： In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigrnoid, Hartmann＇s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage ＂on table＂ prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay （3 to 8 d after the deflation）. All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigrnoidopexy and one patient underwent a near-total colectomy. Two .patients （sigmoidectomy- sigmoidopexy） had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations

关键词： Volvulus Celiotomy Large bowel obstruction Decompression Sigmoidectomy

Presentation and surgical management of xanthogranulomatous cholecystitis

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 117-127页

作者： Maximos Frountzas Dimitrios Schizas Efstathia Liatsou Konstantinos P Economopoulos Christina Nikolaou Konstantinos G Apostolou Konstantinos G Toutouzas evangelos felekouras First Propaedeutic Department of Surgery Hippocration General HospitalNational and Kapodistrian University of AthensSchool of Medicine114 Vas.Sofias Ave.11527AthensGreece Laboratory of Experimental Surgery and Surgical Research National and Kapodistrian University of AthensSchool of Medicine15B Ag.Thoma Str.11527AthensGreece First Department of Surgery Laikon General HospitalNational and Kapodistrian University of AthensSchool of Medicine17 Ag.Thoma Str.11527AthensGreece Society of Junior Doctors Surgery Workgroup75 Mikras Asias Str.11527AthensGreece Department of Surgery Duke University Medical Center2301 Erwin RdDurhamNC 27707USA

Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical *** addition,distinguishing XGC from gallbladder cancer preoperatively is still a *** aim of the present systematic review was to outline the clinical presentation and surgical approach of *** sources:The present systematic review was designed using the PRISMA and AMSTAR *** searched MEDLINE,Scopus,***,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June ***:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for *** important conversion rate(35%)was observed as *** XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi *** addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for ***:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder *** mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.

关键词： Xanthogranulomatous cholecystitis Surgical management Pathology Postoperative complications

Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer

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World Journal of Gastroenterology 2009年第44期15卷 5568-5572页

作者： John Griniatsos Hara Gakiopoulou Eugenia Yiannakopoulou Nikoletta Dimitriou Gerasimos Douridas Afrodite Nonni Theodoros Liakakos evangelos felekouras 1st Department of Surgery University of AthensMedical School LAIKO HospitalGR 115-27AthensGreece Department of Pathology University of AthensMedical SchoolLAIKO HospitalGR 115-27AthensGreece 3rd Department of Surgery University of AthensMedical SchoolATTIKO HospitalGR 115-27Athens Greece

AIM： To evaluate routine modified D2 lymphadenectomy in gastric cancer, based on immunohistochemicaUy detected skip micrometastases in level 11 lymph nodes. METHODS： Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy, from January 2004 to December 2008, 32 were classified as pN0. All level I lymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the level Ⅰ lymph node stations （n = 4） were excluded from further analysis. The level 11 lymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS： Skip micrometastases in the level Ⅱ lymph nodes were detected in 14% （4 out of 28） of the patients. The incidence was further increased to 17% （4 out of 24） in the subgroup of T1-2 gastric cancer patients. All micrometastases were detected in the No. 7 lymph node station. Thus, the disease was upstaged from stage Ⅰ A to Ⅰ B in one patient and from stage Ⅰ B to Ⅱ in three patients. CONCLUSION： In gastric cancer, true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2＋/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.

关键词： Gastric cancer D2 gastrectomy D2 lymphadenectomy Micrometastases Skip metastases Skip micrometastases

Relation between common polymorphisms in genes related to inflammatory response and colorectal cancer

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World Journal of Gastroenterology 2006年第31期12卷 5037-5043页

作者： George Theodoropoulos Ioannis Papaconstantinou evangelos felekouras Nikolaos Nikiteas Petros Karakitsos Dimitris Panoussopoulos Andreas Ch Lazaris Efstratios Patsouris John Bramis Maria Gazouli 1st Propaideutic Surgical DepartmentHippocration University Hospital School of MedicineUniversity of AthensGreece 1st Surgical DepartmentLaikon University Hospital University of AthensGreece Department of PathologySchool of Medicine University of AthensGreece 2nd Propaideutic Surgical DepartmentLaikon University Hospital University of AthensGreece Department of CytopathologyUniversity General Hospital "Artikon" University of AthensGreece Department of BiologySchool of Medicine University of AthensGreece

AIM： To investigate the association between common single nucleotide polymorphisms （SNPs） in inflammatory response-related genes such as interleukin （IL）-6, IL-8, tumor necrosis factor α （TNFα）, peroxisome proliferators-activated receptor γ （PPARγ）, intercellular adhesion molecule-1 （ICAM-1） and the risk of colorectal cancer （CRC） in a group of Greek patients. METHODS： The study group consisted of 222 CRC patients and 200 healthy controls. Genotyping was performed using allele-specific PCR of PRC-RFLP and the results were confirmed by sequencing. We studied the association of SNPs in the IL-6 （-174G 〉 C）, IL-8 （-251T 〉 A）, TNFα （-308G 〉 A）, ICAM-1 （R241G and K469E）, and PPARγ （Pro12Ala） genes and the risk of CRC. RESULTS： The IL-6 -174G, R241 and K469 alleles of ICAM-1 were associated with increased risk of CRC （OR = 1.77, 95% CI： 1.34-2.34; OR = 1.83, 95% CI： 1.23-2.72; and OR = 1.35, 95% CI： 1.03-1.77 respectively）. The IL-8 and TNFα polymorphisms had no effect. Whereas the PPARγ Pro12 genotype was associated with increased risk of disease （OR = 1.78, 95% CI： 1.25-2.49）. CONCLUSION： The association between common SNPs in immunologic response-related genes and CRC is reported in the present study. Apart from shedding light on the mechanisms of malignancy initiation and progression, SNPs may improve appropriate screening for sub-populations at risk.

关键词： Colorectal cancer Inflammation Single nucleotide polymorphisms

Circadian variation in expression of G_1 phase cyclins D_1 and E and cyclin-dependent kinase inhibitors p16 and p21 in human bowel mucosa

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World Journal of Gastroenterology 2006年第13期12卷 2109-2114页

作者： John Griniatsos Othon P Michail Stamatios Theocharis Antonios Arvelakis Ioannis Papaconstantinou evangelos felekouras Emmanouel Pikoulis Ioannis Karavokyros Chris Bakoyiannis George Marinos John Bramis Panayiotis O Michail 1st Department of Surgery Medical School University of AthensGreece Department of Forensic Medicine and Toxicology Medical School University of AthensGreece

AIM： To evaluate whether the cellular proliferation rate in the large bowel epithelial cells is characterized by circadian rhythm. METHODS： Between January 2003 and December 2004, twenty patients who were diagnosed as suffering from primary, resectable, non-metastatic adenocarcinoma of the lower rectum, infiltrating the sphincter mechanism, underwent abdominoperineal resection, total mesorectal excision and permanent left iliac colostomy. In formalinfixed and paraffin-embedded biopsy specimens obtained from the colostomy mucosa every six hours （00：00, 06：00, 12：00, 18：00 and 24：00）, we studied the expression of G1 phase cyclins （D1 and E） as well as the expression of the G1 phase cyclin-dependent kinase （CDK） inhibitors p16 and p21 as indicators of cell cycle progres- sion in colonic epithelial cells using immunohistochemical methods. RESULTS： The expression of both cyclins showed a similar circadian fashion obtaining their lowest and highest values at 00：00 and 18：00, respectively （P〈 0.001）. A circadian rhythm in the expression of CDK inhibitor proteins p16 and p21 was also observed, with the lowest levels obtained at 12：00 and 18：00 （P〈0.001）, respectively. When the complexes cyclins D1-p21 and E-p21 were examined, the expression of the cyclins was adversely correlated to the p21 expression throughout the day. When the complexes the cyclins D1-p16 and E-p16 were examined, high levels of p16 expression were correlated to low levels of cyclin expression at 00：00, 06：00 and 24：00. Meanwhile, the highest expression levels of both cyclins were correlated to high levels of p16 expression at 18：00. CONCLUSION： Colonic epithelial cells seem to enter the G1 phase of the cell cycle during afternoon （between 12：00 and 18：00） with the highest rates obtained at 18：00. From a clinical point of view, the present results suggest that G1-phase specific anticancer therapies in afternoon might maximize their anti-tumor effect while minimizing toxicity.

关键词： G1 phase proteins CDK inhibitors Cell proliferation Circadian rhythm

Angiomyolipoma arising in the gluteal region

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Chinese Medical Journal 2007年第14期120卷 1284-1286页

作者： Emmanouil Pikoulis Constantine Bramis Othon Michail George Liapis evangelos felekouras Vassiliki Kyriakou John Griniatsos First Department of Surgery Laikon Hospital University of Athens Medical SchoolAthens 115-27Greece Department of Pathology Laikon Hospital University of Athens Medical SchoolAthens 115-27Greece

Angiomyolipoma （AML） is a tumour of uncertain .histogenesis originally believed to be a hamartomatous lesion, but recently recognized as a usually benign clonal mesenchymal neoplasm. Along with lymphagiomyomatosis （LAM）, clear cell ＂sugar＂ turnout （CCST） and clear cell myelomelanocytic tumour （CCMMT）, AML was classified in the so called perivascular epithelioid cell （PEComa） neoplasm family.

关键词： angiomyolipoma buttocks