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Ymittos Athens, Greece

Matthaios D.,Democritus University of Thrace | Foukas P.G.,National and Kapodistrian University of Athens | Kefala M.,National and Kapodistrian University of Athens | Hountis P.,Athens Naval and Veterans Hospital | And 7 more authors.
OncoTargets and Therapy | Year: 2012

Background: Phosphorylation of the H2AX histone is an early indicator of DNA double- strand breaks and of the resulting DNA damage response. In the present study, we assessed the expression and prognostic significance of γ-H2AX in a cohort of 96 patients with operable non-small cell lung carcinoma. Methods: Ninety-six paraffin-embedded specimens of non-small cell lung cancer patients were examined. All patients underwent radical thoracic surgery of primary tumor (lobectomy or pneumonectomy) and regional lymph node dissection. γ-H2AX expression was assessed by standard immunohistochemistry. Follow-up was available for all patients; mean duration of follow-up was 27.50 ± 14.07 months (range 0.2-57 months, median 24 months). Results: Sixty-three patients (65.2%) died during the follow-up period. The mean survival time was 32.2 ± 1.9 months (95% confidence interval [CI]: 28.5-35.8 months; median 30.0 months); 1-, 2- and 3-year survival rates were 86.5% ± 3.5%, 57.3% ± 5.1%, and 37.1% ± 5.4%, respectively. Low γ-H2AX expression was associated with a significantly better survival as compared with those having high γ-H2AX expression (35.3 months for low γ-H2AX expression versus 23.2 months for high γ-H2AX expression, P = 0.009; hazard ratio [HR] 1.95, 95% CI: 1.15-3.30). Further investigation with multivariate Cox proportional hazards regression analysis revealed that high expression of γ-H2AX remained an independent prognostic factor of shorter overall survival (HR 2.15, 95% CI: 1.22-3.79, P = 0.026). A combined p53/γ-H2AX analysis was performed, and we found that the p53 low/γ-H2AX low phenotype was associated with significantly better survival compared with all other phenotypes. Conclusion: Our study is the frst to demonstrate that expression of γ-H2AX detected by immunohistochemistry may represent an independent prognostic indicator of overall survival in patients with non-small cell lung cancer. Further studies are needed to confirm our results. © 2012 Matthaios et al, publisher and licensee Dove Medical Press Ltd.

Gouvas N.,Colorectal Unit | Georgiou P.A.,Imperial College London | Agalianos C.,Athens Naval and Veterans Hospital | Tan E.,Imperial College London | And 3 more authors.
Colorectal Disease | Year: 2015

Aim: Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt rectal prolapse (ORP) and obstructed defaecation syndrome (ODS). The present study reviews the short-term and functional results of laparoscopic VR. Method: A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VR for ORP, ODS and other anatomical abnormalities of the pelvic floor from 2004 until February 2013. No language restrictions were made. All studies on VR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, recurrence of ORP, recurrence of anatomical disorder, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Results: Twenty-three studies including 1460 patients were eligible for analysis. The conversion rate ranged from 0 to 14.3%. No mortality was reported. The immediate postoperative morbidity rate was 8.6%. Length of stay ranged from 1 to 7 days. A significant improvement in constipation and incontinence symptoms was observed in the postoperative period for both ORP and ODS (chi-square test, P < 0.0001). Conclusion: Laparoscopic VR is a safe and effective procedure for ORP and ODS. Longer follow-up is required, and studies comparing VR with standard rectopexy and stapled transanal rectal resection are not yet available. © 2014 The Association of Coloproctology of Great Britain and Ireland.

Gouvas N.,National and Kapodistrian University of Athens | Tsiaoussis J.,National and Kapodistrian University of Athens | Athanasakis E.,University of Crete | Zervakis N.,Creta Interclinic Hospital of Heraklion | And 3 more authors.
Diseases of the Esophagus | Year: 2011

Laparoscopic repair of paraesophageal hernia (PEH) involves removal of the hernia sac, cruroplasty, and fundoplication. Mesh application to cruroplasty seems to reduce hernia recurrence rate, but may be associated with dysphagia. The aim of the study was to review the clinical and laboratory outcomes of a series of patients with PEH after laparoscopic repair. Patients with PEH, who had laparoscopic repair and 1-year postoperative follow-up, were included in the study. Pre- and postoperative testing included symptom questionnaires, barium esophagogram, pH-monitoring, barium swallow testing. In the first half cases, suturing of large hernia gaps was reinforced with prosthesis (PR), whereas in the second half only suture cruroplasty (SC) was performed. Sixty-eight patients (36 male) with PEH were included in the study. There were no conversions to open. Postoperatively, dysphagia grading was significantly correlated to esophageal transit time (P < 0.001). There were seven recurrences; one paraesophageal and six wrap migrations. Also, four cases with stenosis were identified all in the PR group. Dysphagia was more common (P= 0.05) and esophageal transit more delayed (P= 0.034) after PR than after SC. Two revisions, one for esophageal stenosis and one for recurrent PEH, derived from the SC group. Reflux was more common after Toupet fundoplication than after Nissen fundoplication (NF) (P= 0.031) in patients with impaired esophageal motility. Laparoscopic repair of PEH with SC is associated with satisfactory clinical outcomes and low rate of wrap migration, at least similar to PR hiatal repair. NF is effective as an antireflux procedure in all cases. © 2010 Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Agalianos C.,Konstantopouleion General Hospital | Paraskeva K.,Konstantopouleion General Hospital | Gouvas N.,Konstantopouleion General Hospital | Davides D.,Athens Naval and Veterans Hospital | Dervenis C.,Konstantopouleion General Hospital
Langenbeck's Archives of Surgery | Year: 2016

Purpose: There are conflicting views regarding preoperative biliary drainage in patients undergoing pancreatectomy. The aim of this study was to evaluate the effect of jaundice resolution on postoperative outcomes. Methods: Patients who underwent pancreatectomy in a single institution since 2010 were retrospectively analyzed. They were divided into two groups, depending on the presence or not of preoperative biliary drainage. Postoperative morbidity and mortality were evaluated. Results: Ninety-nine patients underwent biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) (PBD group), while 105 patients had no biliary drainage (non-PBD group). No significant difference between the two groups could be identified in terms of overall complications (p = 0.121) or mortality (p = 1). There was no significant difference regarding pancreatic fistula (p = 0.554), delayed gastric emptying (p = 0.127), hemorrhage (p = 0.426), number of reoperations (p = 1.000) or readmissions (p = 1.000). The only significant difference was found in the hospital stay, where patients who underwent preoperative biliary drainage had a prolonged length of stay of more 3 days (15.52 vs. 11.31) (p < 0.001). Conclusion: Preoperative biliary drainage in patients undergoing pancreatectomy does not increase the rates of postoperative morbidity or mortality, but has a negative effect on hospital stay. © 2015, Springer-Verlag Berlin Heidelberg.

Gouvas N.,Agia Olga Hospital of Athens | Pechlivanides G.,Athens Naval and Veterans Hospital | Zervakis N.,Creta Interclinic Hospital | Kafousi M.,Creta Interclinic Hospital | Xynos E.,Creta Interclinic Hospital
Colorectal Disease | Year: 2012

Background Complete mesocolic excision (CME) with central vessel ligation (CVL) as performed in Erlangen offers the best long-term outcome for colon cancer. The aim of this study was to assess specimens after laparoscopic vs open CME-CVL macroscopically and morphometrically in patients with left and right colon cancers. Method All specimens were freshly photographed. Precise tumour morphometry and grading of the surgical plane were performed as described by pathologists in Leeds, UK. Results Thirty-four specimens from right-sided cancers were divided into 18 transverse colon cancers (nine laparoscopic vs nine open) and 16 caecum-ascending colon cancers (seven laparoscopic vs nine open) and 56 specimens from left-sided cancers (33 laparoscopic vs 23 open). There was no difference between laparoscopically and open acquired left- and right-sided specimens. Specimens of transverse colon displayed differences in length of central ligation to tumour (open 11.67cm vs laparoscopic 8.72cm, P=0.049), length of central ligation to bowel wall (open 9.11cm vs laparoscopic 6.5cm, P=0.015) and lymph node clearance (open 46.33 vs laparoscopic 39.33, P=0.033). Conclusion Laparoscopy seems to offer specimens of similar quality after CME-CVL surgery for colon cancer to the open approach. Issues of completeness of excision from laparoscopy are raised for tumours located in the transverse colon. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

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