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Management of obstructed colorectal carcinoma in an emergency setting:An update

World Journal of Gastrointestinal Oncology 2024年第3期16卷 598-613页

作者： efstathios T pavlidis Ioannis N Galanis theodoros e pavlidis 2nd Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Colorectal carcinoma is common,particularly on the left *** 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/*** best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains *** the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or *** operative plan should be either one-stage or two-stage ***-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and ***-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of *** control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or *** the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic *** role of minimally invasive surgery(laparoscopic or robotic)is a subject of *** laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic *** decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival *** combination with neoadjuvant chemotherapy or radiation may have a p

关键词： Acute abdomen Obstructive ileus Colorectal carcinoma emergency surgery Colectomy Intraluminal metal stents

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New trends in diagnosis and management of gallbladder carcinoma

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 13-29页

作者： efstathios T pavlidis Ioannis N Galanis theodoros e pavlidis ^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Gallbladder(GB)carcinoma,although relatively rare,is the most common biliary tree cholangiocarcinoma with aggressiveness and poor *** is closely associated with cholelithiasis and long-standing large(>3 cm)gallstones in up to 90%of *** other main predisposing factors for GB carcinoma include molecular factors such as mutated genes,GB wall calcification(porcelain)or mainly mucosal microcalcifications,and GB polyps≥1 cm in *** is made by ultrasound,computed tomography(CT),and,more precisely,magnetic resonance imaging(MRI).Preoperative staging is of great importance in decisionmaking regarding therapeutic *** staging is based on MRI findings,the leading technique for liver metastasis imaging,enhanced three-phase CT angiography,or magnetic resonance angiography for major vessel *** is also necessary to use positron emission tomography(PeT)-CT or ^(18)F-FDG PeT-MRI to more accurately detect metastases and any other occult deposits with active metabolic *** laparoscopy may detect dissemination not otherwise found in 20%-28.6%of *** treatment is needed,including surgical resection,targeted therapy by biological agents according to molecular testing gene mapping,chemotherapy,radiation therapy,and *** is of great importance to understand the updated guidelines and current treatment *** extent of surgical intervention depends on the disease stage,ranging from simple cholecystectomy(T1a)to extended resections and including extended cholecystectomy(T1b),with wide lymph node resection in every case or IV-V segmentectomy(T2),hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y,and adjacent organ resection if necessary(T3).Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery,but much attention must be paid to avoiding *** addition to surgery,novel targe

关键词： Biliary tract neoplasms extrahepatic cholangiocarcinoma Gallbladder carcinoma Gallbladder diseases Biliary tree diseases Gastrointestinal malignancies

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Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

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World Journal of Gastroenterology 2024年第10期30卷 1461-1465页

作者： efstathios T pavlidis Ioannis N Galanis theodoros e pavlidis 2^(nd) Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Pancreatobiliary intraductal papillary neoplasms(IPNs)represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and *** advances in diagnostic methods,identifying these premalignant lesions is still challenging for treatment *** imaging,biomarkers and molecular tests for genomic alterations can be used for diagnosis and *** intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant *** balance between the risk of malignancy and any risk of resection guides management policy;therefore,treatment should be individualized based on a meticulous preoperative assessment of high-risk *** of the bile duct is more aggressive;thus,early diagnosis and surgery are *** conservative management of low-risk pancreatic branch-duct lesions is safe and effective.

关键词： Biliary tree diseases Pancreatic cystic neoplasms Biliary tract neoplasms extrahepatic cholangiocarcinoma Pancreatic adenocarcinoma

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Current considerations for the surgical management of gallbladder adenomas

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1507-1512页

作者： efstathios T pavlidis Ioannis N Galanis theodoros e pavlidis The Second Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in *** detection and management are crucial for preventing lethal carcinoma *** polyps can often be distinguished from the more often nonneo-plastic cholesterol pseudopolyps(5%-10%),which are *** is the first-line tool for initial diagnosis and follow-up when *** question is whether cholecystectomy is always necessary for all *** manage-ment of gallbladder adenomas is determined according to the size of the tumor,the growth rate of the tumor,the patient’s symptoms and whether risk factors for malignancy are ***≥1 cm in size,an age>50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic ***,ultrasound follow-up is *** adenomas 6-9 mm in size,the absence of≥2 mm growth at 6 months,one year,and two years,as well as an adenoma sizedexisting risk factors indicates that no further surveillance is ***,it would be preferable to individualize the management in doubtful *** interventional modalities for preserving the gallbladder need further evaluation,especially to determine the long-term outcomes.

关键词： Biliary diseases True neoplastic polyps Gallbladder adenomas Benign bi-liary tumors Gallbladder polyps extrahepatic biliary neoplasms

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Critical considerations for the management of acute abdomen in transplant patients

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World Journal of Transplantation 2024年第2期14卷 8-12页

作者： efstathios T pavlidis Georgios Katsanos Athanasios Kofinas Georgios Tsoulfas Ioannis N Galanis theodoros e pavlidis The 2^(nd)Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Center for Research and Innovation in Solid Organ TransplantationAristotle University of ThessalonikiSchool of MedicineThessaloniki 54642Greece

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine ***,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute *** problems in immunocompromised patients may not only include graft-related problems but also nongraft-related *** perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these *** perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic *** in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation *** times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and *** computed tomo-graphy is of utmost importance for early diagnosis and *** recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and *** is necessary to follow evidence-based therapeutic ***,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive s

关键词： Acute abdomen Abdominal emergency surgery Transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery

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Management of infected acute necrotizing pancreatitis

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World Journal of Clinical Cases 2023年第2期11卷 482-486页

作者： efstathios T pavlidis theodoros e pavlidis Second Propedeutic Department of Surgery Hippocration HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Necrotizing or severe pancreatitis represents approximately 10%-20%of acute pancreatitis.30%-40%of patients with acute necrotizing pancreatitis(ANP)will develop debris infection through translocation of intestinal microbial *** ANP constitutes a serious clinical condition and is complicated by severe sepsis with high mortality rates of up to 40%despite progress in current intensive *** timely detection of sepsis is *** Quick Sequential Organ Failure Assessment score,procalcitonin levels>1.8 ng/mL and increased lactates>2 mmol/L(>18 mg/dL),indicate the need for urgent *** escalated step-by-step management protocol starts with broad-spectrum antibiotics,percutaneous drainage or endoscopic management,and ends with surgical management if *** latter includes necrosectomy(either laparoscopic or traditional open surgery),peritoneal lavage and extensive *** management protocol increases the chance of survival to approximately 60%in patients with otherwise fatal *** treatment choice must be individualized,and the timing is critical.

关键词： Pancreas Acute abdomen Acute pancreatitis Necrotizing pancreatitis Sepsis Septic shock

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Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

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World Journal of Clinical Cases 2023年第10期11卷 2213-2225页

作者： efstathios T pavlidis theodoros e pavlidis The Second Propedeutic Department of Surgery Hippocration HospitalSchool of MedicineAristotle UniversityThessaloniki 54642Greece

Primary hyperparathyroidism(pHPT)is the third most common endocrine *** surgical procedure aims for permanent cure,but recurrence has been reported in 4%-10%of pHPT *** localization imaging is highly *** includes ultrasound,computed tomography(CT),single-photonemission CT,sestamibi scintigraphy and magnetic resonance *** operation has been defined as successful when postoperative continuous eucalcemia exists for more than the first six *** hypercalcemia during this period is defined as persistence,and recurrence is defined as hypercalcemia after six months of *** D is a crucial factor for a good *** parathyroid hormone(PTH)monitoring can safely predict the outcomes and should be ***≤40 pg/mL or the traditional decrease≥50%from baseline minimizes the likelihood of *** factors for persistence are hyperplasia and normal parathyroid tissue on *** factors for recurrence are cardiac history,obesity,endoscopic approach and low-volume center(at least 31 cases/year).Cases with double adenomas or four-gland hyperplasia have a greater likelihood of persistence/recurrence.A 6-mo calcium>9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 mo may be associated with recurrence necessitating long-term follow-up.18F-fluorocholine positron emission tomography and 4-dimensional CT in persistent and recurrent cases can be valuable before *** these novel advances in preoperative imaging and localization as well as intraoperative PTH measurement,the recurrence rate has dropped to 2.5%-5%.Sixmonth serum calcium≥9.8 mg/dL and parathyroid hormone≥80 pg/mL indicate a risk of *** sestamibi scintigraphy,diabetes and elevated osteocalcin levels are predictors of multiglandular disease,which brings an increased risk of persistence and *** neck exploration was considered the gold-standard diagnostic ***

关键词： Parathyroid hormone Minimally invasive parathyreoidectomy Hyperparathyroidism Primary Reoperation Persistent Recurrent hypercalcemia

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Current management of concomitant cholelithiasis and common bile duct stones

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World Journal of Gastrointestinal Surgery 2023年第2期15卷 169-176页

作者： efstathios T pavlidis theodoros e pavlidis 2^(nd)Propedeutic Department of Surgery Hippocration HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage *** basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDe)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(eRCP-eS)for stone *** most frequently used worldwide option is preoperative eRCP-eS and stone removal followed by LC,preferably on the next *** cases where preoperative eRCP-eS is not feasible,the proposed alternative of intraoperative rendezvous eRCP-eS simultaneously with LC has been *** intraoperative extraction of CBD stones is superior to postoperative rendezvous ***,there is no consensus on the superiority of laparoendoscopic *** is equivalent to a traditional two-stage *** papillary large balloon dilation reduces *** and intraoperative eRCP have similar good *** risk of recurrence after eRCP-eS is greater than that after *** ultrasonography may delineate the anatomy and detect CBD *** majority of surgeons prefer the transcductal instead of the transcystic approach for CBDe with or without T-tube drainage,but the transcystic approach must be used where *** is a safe and effective choice when performed by an experienced ***,the requirement of specific equipment and advanced training are *** percutaneous approach is an alternative when eRCP *** or endoscopic reintervention for retained stones may be *** asymptomatic CBD stones,eRCP clearance is the firstchoice *** one-stage and two-stage management are acceptable and can ensure improved quality of life.

关键词： Biliary diseases Cholelithiasis Choledocholithiasis Gallstones endoscopic management Laparoscopic management

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Hepatic ischemia-reperfusion syndrome and its effect on the cardiovascular system: The role of treprostinil, a synthetic prostacyclin analog

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1858-1870页

作者： Christina Mouratidou efstathios T pavlidis Georgios Katsanos Serafeim-Chrysovalantis Kotoulas eleni Mouloudi Georgios Tsoulfas Ioannis N Galanis theodoros e pavlidis Intensive Care Unit Hippokration General HospitalThessaloniki 54642Greece 2^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver *** addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and ***,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality *** is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging *** has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/*** improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of *** exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion ***,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.

关键词： Hepatic ischemia-reperfusion syndrome Myocardial damage Prostaglandins Treprostinil Liver transplantation Hepatectomy

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Pathophysiological consequences of obstructive jaundice and perioperative management

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 17-21页

作者： efstathios T pavlidis theodoros e pavlidis Aristotle University of Thessaloniki Medical School Second Surgical Propedeutic Department Hippocration Hospital

Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future *** sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were ***: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected ***: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.

关键词： Obstructive jaundice Perioperative management Preoperative biliary drainage Lactulose endotoxin Biliary obstruction

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