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Double role of depression in gastric cancer:As a causative factor and as consequence

World Journal of Gastroenterology 2024年第10期30卷 1266-1269页

作者： grigorios christodoulidis Koumarelas Konstantinos-Eleftherios Kouliou Marina-Nektaria Department of General Surgery University Hospital of LarissaLarissa 41110Greece

In this editorial we comment on the article“Hotspots and frontiers of the rela-tionship between gastric cancer and depression:A bibliometric study”.Gastric cancer(GC)is a common malignancy in the digestive system with increased mortality and morbidity rates globally.Standard treatments,such as gastrectomy,negatively impact patients'quality of life and beyond the physical strain,GC patients face psychological challenges,including anxiety and depression.The prevalence of depression can be as high as 57%,among gastrointestinal cancer patients.Due to the advancements in treatment effectiveness and increased 5-year overall survival rates,attention has shifted to managing psychological effects.However,the significance of managing the depression doesn’t lie solely in the need for a better psychological status.Depression leads to chronic stress acti-vating the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis,leading release of catecholamines inducing tumor proliferation,migration,and metastasis,contributing to GC progression.The dysregulation of neurotrans-mitters and the involvement of various signaling pathways underscore the complex interplay between depression and GC.Comprehensive strategies are required to address the psychological aspects of GC,including region-specific interventions and increased monitoring for depression.Understanding the intricate relationship between depression and GC progression is essential for developing effective therapeutic strategies and improving overall outcomes for patients facing this complex disease.In this Editorial we delve into double role of depression in the pathogenesis of GC and as a complication of it.

关键词： Gastric cancer Depression Anxiety Chronic stress Pathogenesis of gastric cancer

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Understanding autoimmune pancreatitis: Clinical features, management challenges, and association with malignancies

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World Journal of Gastroenterology 2024年第15期30卷 2091-2095页

作者： grigorios christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Department of General Surgery University Hospital of LarissaUniversity of ThessalyLarissa 41110Greece

In this editorial we comment on the article by Jaber et al.Autoimmune pancreatitis(AIP)represents a distinct form of pancreatitis,categorized into AIP-1 and AIP-2,characterized by obstructive jaundice,lymphoplasmacytic infiltrate,and fibrosis.AIP-1,associated with elevated immunoglobulin G4(IgG4)levels,exhibits higher relapse rates,affecting older males,while AIP-2 is less common and linked to inflammatory bowel disease.AIP is considered a manifestation of IgG4-related systemic disease,sharing characteristic histological findings.Steroids are the primary treatment,with emerging biomarkers like interferon alpha and inter-leukin-33.AIP poses an increased risk of various malignancies,and the assoc-iation with pancreatic cancer is debated.Surgery is reserved for severe cases,necessitating careful evaluation due to diagnostic challenges.AIP patients may have concurrent PanINs but display favorable long-term outcomes compared to pancreatic cancer patients.Thorough diagnostic assessment,including biopsy and steroid response,is crucial for informed surgical decisions in AIP.

关键词： Autoimmune pancreatitis Immunoglobulin G4-related disease Pancreatic cancer Surgery

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Revolutionizing gastric cancer treatment:The potential of immunotherapy

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World Journal of Gastroenterology 2024年第4期30卷 286-289页

作者： grigorios christodoulidis Konstantinos Eleftherios Koumarelas Marina Nektaria Kouliou Department of General Surgery University Hospital of LarissaLarissa 41110Greece

Gastric cancer,a prevalent malignancy worldwide,ranks sixth in terms of frequency and third in fatality,causing over a million new cases and 769000 annual deaths.Predominant in Eastern Europe and Eastern Asia,risk factors include family medical history,dietary habits,tobacco use,Helicobacter pylori,and Epstein-Barr virus infections.Unfortunately,gastric cancer is often diagnosed at an advanced stage,leading to a grim prognosis,with a 5-year overall survival rate below 5%.Surgical intervention,particularly with D2 Lymphadenectomy,is the mainstay for early-stage cases but offers limited success.For advanced cases,the National Comprehensive Cancer Network recommends chemotherapy,radiation,and targeted therapy.Emerging immunotherapy presents promise,especially for unresectable or metastatic cases,with strategies like immune checkpoint inhibitors,tumor vaccines,adoptive immunotherapy,and nonspecific immunomodulators.In this Editorial,with regards to the article“Advances and key focus areas in gastric cancer immunotherapy:A comprehensive scientometric and clinical trial review”,we address the advances in the field of immunotherapy in gastric cancer and its future prospects.

关键词： Immunotherapy Adaptive immunotherapy Tumor vaccines Chimeric antigen receptor therapy Tumor-infiltrating lymphocytes therapy Natural killer therapy Cytokine-induced killer therapy Engineered T cell receptor therapy Immune checkpoint inhibitors

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Immune signature of small bowel adenocarcinoma and the role of tumor microenvironment

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World Journal of Gastroenterology 2024年第8期30卷 794-798页

作者： grigorios christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Department of General Surgery University Hospital of LarissaLarissa 41110Greece

In this editorial we comment on the article published“Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment”.Small bowel adenocarcinoma(SBA)is a rare gastrointestinal neoplasm and despite the small intestine's significant surface area,SBA accounts for less than 3%of such tumors.Early detection is challenging and the reason arises from its asymptomatic nature,often leading to late-stage discovery and poor prognosis.Treatment involves platinum-based chemotherapy with a 5-fluorouracil combination,but the lack of effective chemotherapy contributes to a generally poor prognosis.SBAs are linked to genetic disorders and risk factors,including chronic inflammatory conditions.The unique characteristics of the small bowel,such as rapid cell renewal and an active immune system,contributes to the rarity of these tumors as well as the high intratumoral infiltration of immune cells is associated with a favorable prognosis.Programmed cell death-ligand 1(PD-L1)expression varies across different cancers,with potential discrepancies in its prognostic value.Microsatellite instability(MSI)in SBA is associated with a high tumor mutational burden,affecting the prognosis and response to immunotherapy.The presence of PD-L1 and programmed cell death 1,along with tumor-infiltrating lymphocytes,plays a crucial role in the complex microenvironment of SBA and contributes to a more favorable prognosis,especially in the context of high MSI tumors.Stromal tumor-infiltrating lymphocytes are identified as independent prognostic indicators and the association between MSI status and a favorable prognosis,emphasizes the importance of evaluating the immune status of tumors for treatment decisions.

关键词： Programmed cell death 1 Programmed cell death-ligand 1 Programmed death ligand Small bowel adenocarcinoma Tumor infiltrating lymphocytes Tumor microenvironment Microsatellite instability

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Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 514-526页

作者： Stylianos Fiflis grigorios christodoulidis Menelaos Papakonstantinou Alexandros Giakoustidis Stergos Koukias Paraskevi Roussos Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Dimitrios Giakoustidis First Department of Surgery General Hospital PapageorgiouThessaloniki 56429Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

BACKGROUND Gastric cancer is the third most common cause of cancer related death worldwide.Surgery with or without chemotherapy is the most common approach with curative intent;however,the prognosis is poor as mortality rates remain high.Several indexes have been proposed in the past few years in order to estimate the survival of patients undergoing gastrectomy.The preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been developed.The aim of this systematic review was to assess the role of the prognostic nutritional index(PNI)in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative intent.AIM To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction adenocarcinoma.METHODS A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival(OS)of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI value.The PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic review.The review protocol was registered in the International Prospective Register of Systematic Reviews(PRO) RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic review.The patients were divided into high-and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual study.The 5-year OS of patients in the low-PNI groups ranged between 39%and 70.6%,while in the high-PNI groups,it ranged between 54.9%and 95.8%.In most of the included studies,patients with high preoperative PNI showed

关键词： Prognostic nutritional index Gastric adenocarcinoma Gastroesophageal junction cancer Prognosis Overall survival

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Pivotal role of exosomes in diagnosis and treatment of esophageal cancer in a new era of precision medicine

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World Journal of Methodology 2024年第1期14卷 1-5页

作者： grigorios christodoulidis Konstantinos Eleftherios Koumarelas Marina Nektaria Kouliou Department of General Surgery University Hospital of LarissaLarissa 41110Greece

In this editorial we comment on the article published by Ning et al,“Role of exosomes in metastasis and therapeutic resistance in esophageal cancer”.Esophageal cancer(EC)represents a significant global health concern,being the seventh most common and sixth in terms of mortality worldwide.Despite the advances in therapeutic modalities,the management of patients with EC remains challenging,with a 5-year survival rate of only 25%and a limited eligibility for curative surgery due to its late diagnosis.Conventional screening methods are impractical for the early detection of EC,given their either invasive or insensitive nature.The advent of liquid biopsy,with a focus on circulating tumor cells,circulating tumor DNA,and exosomes,heralds a non-invasive avenue for cancer detection.Exosomes,small vesicles involved in intercellular communication,are highlighted as potential biomarkers for EC diagnosis and prognosis.Along with a diverse cargo encompassing various types of RNA,DNA molecules,proteins,and metabolites,exosomes emerge as key players in tumorigenesis,tumor development,and metastasis.Their significance extends to carrying distinctive biomarkers,including microRNAs(miRNAs),long non-coding RNAs,and circular RNAs,underscoring their potential diagnostic and prognostic value.Furthermore,exosomes may be utilized for therapeutic purposes in the context of EC treatment,serving as efficient delivery vehicles for therapeutic agents such as chemotherapeutic medicines and miRNAs.In this editorial we delve into the applications of exosomes for the early detection and treatment of EC,as well as the future perspectives.

关键词： Exosomes Esophageal cancer Diagnostic methods Novel therapies

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Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

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World Journal of Methodology 2024年第1期14卷 71-79页

作者： grigorios christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Konstantinos Argyriou Garyfallia Apostolia Karali Konstantinos Tepetes Department of General Surgery University Hospital of LarissaLarissa 41110Greece Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,Billroth II among them.Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(Billroth II:74 patients and Billroth II and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(Pchristodoulidis G et al.Billroth II and Braun compared with Billroth II WJM https://*** 2 March 20,2024 Volume 14 Issue 1 Billroth II and Braun anastomosis were presented with the same conditions(P<0.05).CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux,alkaline gastritis and NGT output.

关键词： Billroth II Billroth II and Braun Reconstruction techniques Gastrectomy Distal gastrectomy

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Giant abdominal osteosarcoma causing intestinal obstruction treated with resection and adjuvant chemotherapy

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World Journal of Gastrointestinal Surgery 2017年第2期9卷 68-72页

作者： Alexandros Diamantis grigorios christodoulidis Dionysia Vasdeki Foteini Karasavvidou Evangelos Margonis Konstantinos Tepetes Depart-ment of General Surgery University Hospital of Larisa Division of Anatomic Pathology Univer-sity Hospital of Larisa

Extraskeletal osteosarcoma(ESOS)is an uncommon tumor that accounts for 1% of all soft tissue sarcomas and 4% of all osteosarcomas. Its presentation may be atypical,while pain has been described as the most common symptom. Radiological findings include a large mass in the soft-tissues with massive calcifications,but no attachment to the adjacent bone or periosteum. We present the case of a 73-year-old gentle man who presented with a palpable,tender abdominal mass and symptoms of bowel obstruction. Computer tomography images revealed a large space-occupying heterogeneous,hyper dense soft tissue mass involving the small intestine. Explorative laparotomy revealed a large mass in the upper mesenteric root of the small intestine,measuring 22 cm × 12 cm × 10 cm in close proximity with the cecum,which was the cause of the bowel obstruction. Pathology confirmed the diagnosis of an ESOS. ESOS is an uncommon malignant soft tissue tumor with poor prognosis and a 5-year survival rate of less than 37%. Regional recurrence and distant metastasis to lungs,regional lymph nodes and liver can occur within the first three years of diagnosis in a high rate(45% and 65% respectively). Wide surgical resection of the mass followed by adjuvant chemotherapy or radiotherapy has been the treatment of choice.

关键词： Osteosarcoma 肉瘤 Extraskeletal 肠的阻塞腹的质量软织物

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Heterotopic pancreas in the stomach:A case report and literature review

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World Journal of Gastroenterology 2007年第45期13卷 6098-6100页

作者： grigorios christodoulidis Dimitris Zacharoulis Sotiris Barbanis Emmanuel Katsogridakis Konstantine Hatzitheofilou Department of Surgery University Hospital of Larissa Larissa41221 Greece

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathologic changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 40 years old woman with epigastric pain due to ectopic pancreatic tissue in the stomach is described. The difficulty of making an ac- curate diagnosis is highlighted. The patient has remained free of symptoms since she underwent wedge resection of the lesion three years ago. Frozen sections may help in deciding the extent of resection intraoperatively. Al- though ectopic pancreas is rare, it should be considered in the differential diagnosis of a submucosal gastric tumour.

关键词：胰腺异位胃疾病组织学手术治疗

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colorectal 癌症阶段特征上的 antiplatelet 治疗的影响

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World Journal of Gastrointestinal Endoscopy 2012年第9期4卷 409-413页

作者： Dimitrios Symeonidis Georgios Koukoulis grigorios christodoulidis Ioannis Mamaloudis Ioannis Chatzinikolaou Konstantinos Tepetes Department of General Surgery University Hospital of LarissaMezourlo 41110LarissaGreece

AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the res

关键词： Colorectal cancer Antiplatelets Cancer stage Abdominal surgery Colonoscopy

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