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| 1 | Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy显示文摘BACKGROUND: Enhanced recovery after surgery(ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy. METHODS: Fifty patients who had received conventional peri operative management from 2005 to 2009(conventional group)were compared with 75 patients who had received perioperative care with an ERAS protocol(fast-track group) from 2010 to2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.RESULTS: Compliance with each element of the ERAS pro tocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol(87.5% vs40.7%; P<0.001). There were no significant differences in de mographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and over all morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reduc ing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.CONCLUSION: ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay. | Efstratios Zouros Theodoros Liakakos Anastasios Machairas Paulos Patapis Christos Agalianos Christos Dervenis | 2016 | Hepatobiliary & Pancreatic Diseases International2016，15，2： | 16 |
| 2 | Laparoscopic splenectomy:Current concepts显示文摘Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes. | Evangelos P Misiakos George Bagias Theodore Liakakos Anastasios Machairas | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，9： | 14 |
| 3 | Cytopathologic diagnosis of fine needle aspiration biopsies of thyroid nodules显示文摘Fine-needle aspiration(FNA) cytology is an important diagnostic tool in patients with thyroid lesions.Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules.However cases with indeterminate cytological findings still remain a matter of debate.In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules.A review of the English literature was conducted,and data were analyzed and summarized and integrated from the authors' perspective.The main purpose of thyroid FNA is to identify patients with higher risk for malignancy,and to prevent unnecessary surgeries for benign conditions.The Bethesda System for Reporting Thyroid Cytopathology is the most widely used system for the diagnosis of thyroid FNA specimens.This system also contains guidelines for the diagnosis and treatment of indeterminate or suspicious for malignancy cases.In conclusion,patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. | Evangelos P Misiakos Niki Margari Christos Meristoudis Nickolas Machairas Dimitrios Schizas Konstantinos Petropoulos Aris Spathis Petros Karakitsos Anastasios Machairas | 2016 | World Journal of Clinical Cases2016，4，2： | 12 |
| 4 | TYMS/KRAS/BRAF molecular profiling predicts survival following adjuvant chemotherapy in colorectal cancer显示文摘BACKGROUND Patients with stage II-III colorectal cancer (CRC) treated with adjuvant chemotherapy, gain a 25% survival benefit. In the context of personalized medicine, there is a need to identify patients with CRC who may benefit from adjuvant chemotherapy. Molecular profiling could guide treatment decisions in these patients. Thymidylate synthase (TYMS) gene polymorphisms, KRAS and BRAF could be included in the molecular profile under consideration. AIM To investigate the association of TYMS gene polymorphisms, KRAS and BRAF mutations with survival of CRC patients treated with chemotherapy.METHODS A retrospective study studied formalin-fixed paraffin-embedded tissues (FFPEs) of consecutive patients treated with adjuvant chemotherapy during January/2005-January/2007. FFPEs were analysed with PCR for the detection of TYMS polymorphisms, mutated KRAS (mKRAS) and BRAF (mBRAF). Patients were classified into three groups (high, medium and low risk) according to 5’UTR TYMS polymorphisms Similarly, based on 3’UTR polymorphism ins/loss of heterozygosity (LOH) patients were allocated into two groups (high and low risk of relapse, respectively). Cox regression models examined the associated 5- year survival outcomes. RESULTS One hundred and thirty patients with early stage CRC (stage I-II: 55 patients;stage III 75 patients;colon: 70 patients;rectal: 60 patients) were treated with surgery and chemotherapy. The 5-year disease free survival and overall survival rate was 61.6% and 73.9% respectively. 5’UTR polymorphisms of intermediate TYMS polymorphisms (2RG/3RG, 2RG/LOH, 3RC/LOH) were associated with lower risk for relapse [hazard ratio (HR) 0.320, P = 0.02 and HR 0.343, P = 0.013 respectively] and death (HR 0.368, P = 0.031 and HR 0.394, P = 0.029 respectively). The 3’UTR polymorphism ins/LOH was independently associated with increased risk for disease recurrence (P = 0.001) and death (P = 0.005). mBRAF (3.8% of patients) was associated with increased risk of death (HR 4.500, P = 0.022) whereas mKRAS (39% of patients) not. CONCLUSION Prospective validating studies are required to confirm whether 2RG/3RG, 2RG/LOH, 3RC/LOH, absence of ins/LOH and wild type BRAF may indicate patients at lower risk of relapse following adjuvant chemotherapy. | Anastasios Ntavatzikos Aris Spathis Paul Patapis Nikolaos Machairas Georgia Vourli George Peros Iordanis Papadopoulos Ioannis Panayiotides Anna Koumarianou | 2019 | World Journal of Gastrointestinal Oncology2019，11，7： | 5 |
| 5 | Integrating TYMS, KRAS and BRAF testing in patients with metastatic colorectal cancer显示文摘AIM To investigate the impact of thymidylate synthase(TYMS), KRAS and BRAF in the survival of metastatic colorectal cancer(m CRC) patients treated with chemotherapy. METHODS Clinical data were collected retrospectively from records of consecutive patients with m CRC treated with fluoropyrimidine-based chemotherapy from 1/2005 to 1/2007. Formalin-fixed paraffin-embedded tissues were retrieved for analysis. TYMS genotypes were identified with restriction fragment analysis PCR, while KRAS and BRAF mutation status was evaluated using real-time PCR assays. TYMS gene polymorphisms of each of the 3' untranslated region(UTR) and 5'UTR were classified into three groups according to the probability they have for high, medium and low TYMS expression(and similar levels of risk) based on evidence from previous studies. Univariate and multivariate survival analyses were performed.RESULTS The analysis recovered 89 patients with m CRC(46.1% de novo metastatic disease and 53.9% relapsed). Of these, 46 patients(51.7%) had colon cancer and 43(48.3%) rectal cancer as primary. All patients were treated with fluoropyrimidine-based chemotherapy(5FU or capecitabine) as single-agent or in combination with irinotecan or/and oxaliplatin or/and bevacizumab. With a median follow-up time of 14.8 mo(range 0-119.8), 85 patients(95.5%) experienced disease progression, and 63 deaths(70.8%) were recorded. The 3-year and 5-year OS rate was 25.4% and 7.7% while the 3-year progression-free survival rate was 7.1%. Multivariate analysis of TYMS polymorphisms, KRAS and BRAF with clinicopathological parameters indicated that TYMS 3'UTR polymorphisms are associated with risk for disease progression and death(P < 0.05 and P < 0.03 respectively). When compared to tumors without any del allele(genotypes ins/ins and ins/loss of heterozygosity(LOH) linked with high TYMS expression) tumors with del/del genotype(low expression group) and tumors with ins/del or del/LOH(intermediate expression group) have lower risk for disease progression(HR = 0.432, 95%CI: 0.198-0.946, P < 0.04 and HR = 0.513, 95%CI: 0.287-0.919, P < 0.03 respectively) and death(HR = 0.366, 95%CI: 0.162-0.827, P < 0.02 and HR = 0.559, 95%CI: 0.309-1.113, P < 0.06 respectively). Additionally,KRAS mutation was associated independently with the risk of disease progression(HR = 1.600, 95%CI: 1.011-2.531, P < 0.05). The addition of irinotecan in 1st line chemotherapy was associated independently with lower risk for disease progression and death(HR = 0.600, 95%CI: 0.372-0.969, P < 0.04 and HR = 0.352, 95%CI: 0.164-0.757, P < 0.01 respectively).CONCLUSION The TYMS genotypes ins/ins and ins/LOH associate with worst prognosis in m CRC patients under fluoropyrimidine-based chemotherapy. Large prospective studies are needed for validation of our findings. | Anastasios Ntavatzikos Aris Spathis Paul Patapis Nikolaos Machairas George Peros Stefanos Konstantoudakis Danai Leventakou Ioannis G Panayiotides Petros Karakitsos Anna Koumarianou | 2017 | World Journal of Gastroenterology2017，23，32： | 4 |
| 6 | 结肠的腺癌和麦芽淋巴瘤的同时的出现: 一系列三个盒子显示文摘 Simultaneous development of adenocarcinoma and primary B cell lymphoma of mucosa-associated lymphoid tissue(MALT) lymphoma of the colon is rare;only one case has so far been reported out of 13 cases with the coexistence of colonic adenocarcinoma with involvement of the colon by lymphoma.We hereby present three more cases,two females(aged 75 and 71 years) and a male(aged 72 years).All three underwent colectomy based on a preoperative biopsy revealing colonic carcinoma.Histological examination of the resection specimens disclosed a colonic adenocarcinoma in two cases,whereas a tubulovillous adenoma with superficial foci of intraepithelial adenocarcinoma was seen in the thirdcase.Moreover,in all three cases,a coexisting MALT lymphoma was diagnosed in the colon(1 case),in both colon and adjacent lymph nodes(1 case) or in colonic lymph nodes and omentum(1 case).In the last case,a post-operative bone marrow biopsy revealed extensive infiltration of the bone marrow,due to which the patient received postoperative chemotherapy.Diagnostic and treatment issues are briefly discussed. | Theodoros Argyropoulos Periklis Foukas Maria Kefala Panagiotis Xylardistos Sotirios Papageorgiou Nikolaos Machairas Evmorfia Boltetsou Anastasios Machairas Ioannis G Panayiotides | 2012 | World Journal of Gastrointestinal Oncology2012，4，4： | 4 |
| 7 | The Effect of Synbiotics on Acute Radiation-Induced Diarrhea and Its Association with Mucosal Inflammatory and Adaptive Responses in Rats显示文摘 | Basileios G. Spyropoulos George Theodoropoulos Evangelos P. Misiakos Christos N. Stoidis Haralambos Zapatis Kalliopi Diamantopoulou Chrisostomi Gialeli Nikos K. Karamanos Gabriel Karatzas Anastasios Machairas Constantinos Fotiadis George C. Zografos Nikol | 2013 | Digestive Diseases and Sciences2013，，9： | 1 |
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