Dimitrios Mantas

Impact of Breast Cancer Surgery on the Self-Esteem and Sexual Life of Female Patients

Patient satisfaction with cosmetic outcome and the psychological impact of breast cancer surgery were evaluated. A total of 207 patients with primary breast cancer, treated with either breast-conserving surgery (n = 83), modified radical mastectomy without reconstruction (n = 108), or mastectomy with delayed breast reconstruction (n = 16) rated their cosmetic outcome and satisfaction following surgery, and the impact of surgery on their self-esteem and sexual life, by questionnaire. Patients undergoing breast-conserving surgery were most satisfied with their surgery and body image, followed by those treated with mastectomy with delayed reconstruction. Although diagnosis of breast cancer had a negative impact on the psychology of all patients, those undergoing breast-conserving surgery or mastectomy with delayed reconstruction were more satisfied and reported a lower impact on their self-esteem and sexual life versus those who only had mastectomy. Diagnosis of breast cancer has a negative psychological impact on the patient, but the type of surgery has a significant role in post-operative self-esteem and sexual life.

Breast arterial calcifications as an indicator of systemic vascular disease

Purpose: To evaluate the association between mammographically detected arterial calcifications and systemic vascular disease. Material and Methods: The medical records of 77 women who had either breast arterial calcifications or underwent surgery for carotid stenosis, abdominal aortic aneurysm, or femoropopliteal bypass (study groups A and B) were evaluated and compared with 33 women without breast arterial calcifications (group C). Patients in both arms of the study underwent additional vascular tests or mammography. Results: Currently available data indicate that there is a statistically significant correlation between the presence of arterial calcifications on the mammogram and atheromatosis of the carotid or femoral arteries. Conclusion: Screening mammograms might be useful in the detection of women at risk for systemic vascular disease.

Metastatic melanoma in the gallbladder: Report of a case

Abstract.Both primary and secondary gallbladder melanomas are rare and, when a solitary melanoma is found in the gallbladder, it is difficult to determine if it is primary or metastatic disease. We report the case of a young woman found to have a single metastatic gallbladder melanoma. Surgical removal of a solitary metastatic focus remains the treatment of choice for isolated metastasis of a malignant melanoma; however, the effectiveness of complementary chemotherapy and immunotherapy is still being examined.

PEDICLED MYOCUTANEOUS AND MUSCLE FLAPS IN THE MANAGEMENT OF COMPLICATED CARDIOTHORACIC PROBLEMS

The purpose of this study was to review our experience with the management of patients with complicated cardiothoracic problems by the use of pedicled myocutaneous or muscle flaps, and discuss the various methods of reconstruction. Over the last 11 years, we have treated 54 patients with complicated cardiothoracic problems by reconstruction with pedicled myocutaneous or muscle flaps. The underlying causes were chest wall tumours (n = 13), radionecrosis of the chest wall (n = 12), deep or chronic sternal infections (n = 25), and bronchopleural fistulas (n = 4). The most commonly used muscles for reconstruction were pectoralis major and the rectus abdominis. Our results compare favourably with those reported elsewhere. We conclude that although the use of pedicled myocutaneous or muscle flaps is not free of complications, it is an effective and reliable method for the management of patients with complicated cardiothoracic problems.

Indications, limitations and maneuvers to enable extended hepatectomy: Current trends

The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic lesions. Surgical resection of these tumors remains the only curative modality. Several limitations, however, do not allow the performance of these operations. This review evaluates the indications and limitations regarding these extended hepatic resections, as well as describing all the manipulations that increase the candidates for such operations. A thorough review of the literature was performed in order to define indications for extended hepatectomy, as well as to present all methods that contribute to increasing the volume of the future remnant liver. The role of portal vein ligation, portal vein embolization, two-stage hepatectomy, and in situ liver transection are evaluated in the setting of indications and results. Extended hepatectomies are a necessity due to oncological reasons. All methods developed in order to increase the volume of the remnant liver are safe and efficient. in situ liver transection is a novel and revolutionary two-step procedure for extended hepatic resections. Further clinical studies are required to estimate long-term results and the oncological basis of this technique.

FAP related periampullary adenocarcinoma

INTRODUCTION The risk of periampullary neoplasia in patients with familial adenomatous polyposis (FAP) is significantly increased compared to the general population. PRESENTATION OF CASE We herein report the case of a 47-year-old woman with classic familial adenomatous polyposis with a history of total proctocolectomy for FAP who presented with an ulcerous ampullary lesion 8 years after primary colorectal surgery. Interestingly, the patient had not enrolled to optimal postoperative upper endoscopy follow-up. The patient underwent a Whipple procedure. Histology demonstrated a T2N0 ampullary adenocarcinoma. DISCUSSION Periampullary disease in patients with familial adenomatous polyposis occurs increasingly, especially in the subset of patients without proper endoscopic follow-up. Current recommendations concerning upper endoscopy and appropriate management are herein discussed; the importance of optimal postoperative endoscopy after total proctocolectomy in the FAP setting is discussed. CONCLUSION Periampullary cancer carries a significant risk in patients with FAP and proper endoscopic follow-up should be applied in this special patient group in order to manage ampullary manifestations of the disease in a timely manner.

Laparoscopic versus open liver resection for hepatocellular carcinoma: initial experience in Greece

Background Liver resection represents the treatment of choice for a small proportion of patients with hepatocellular carcinoma (HCC), amenable to surgery. The remarkable evolution in surgical techniques during the last decades introduced laparoscopic hepatectomy in the operative management of HCC, even in the presence of liver cirrhosis. No comparative study on laparoscopic or open liver resection for HCC has been conducted in Greece yet. Methods Patients undergoing liver resection for HCC by one senior hepatobiliary surgeon in our Institution during the period 11/2011-02/2016 were prospectively sampled and retrospectively analyzed for the purposes of this study. Statistical analysis encompassed Student’s t-test, Fisher’s exact test, the Kaplan-Meier method/log rank test and Cox proportional hazard regression analyses. Results Eleven patients underwent laparoscopic and 21 open liver resection, respectively. Statistical differences between the 2 groups were observed for tumor size (P=0.04), major resections (P=0.01), Pringle maneuver (P=0.008), intraoperative blood transfusion (P=0.03), and duration of operation (P=0.004). Resection margins, and tumor recurrence showed no statistical differences. Three-year postoperative survival after laparoscopic and open hepatectomy was 100%, and 67%, respectively (P=0.06). Regression analysis for patient survival revealed prognostic value for BCLC staging, γ-glutamyl transferase levels, laparoscopic hepatectomy, UICC stage, Dindo-Clavien classification, and hospital stay. Laparoscopic hepatectomy remained as independent predictor of survival by multivariate analysis (P=0.0142). Conclusion Laparoscopic hepatectomy for HCC in chronic liver disease represents a safe and innovative treatment tool in the management of these patients under the presupposition of careful patient selection.

Surgery for liver metastases from breast cancer

INTRODUCTION Liver metastases from breast cancer (BCLM) confer poor survival. Liver resection in BCLM patients has been increasingly employed. AIM We undertook a systematic review to evaluate the role of hepatic resection in patients with breast cancer metastatic to the liver. MATERIALS & METHODS In total, 36 studies were overviewed. Patient populations, characteristics, morbidity, mortality and survival were documented. RESULTS Median overall survival was 41 months. Major morbidity was rare while 30-day postoperative mortality was near nil. CONCLUSION Liver surgery for BCLM can be performed with low mortality, acceptable morbidity and promising survival benefit in carefully selected patients.

Differential Expression of β-Catenin, EGFR, CK7, CK20, MUC1, MUC2, and CDX2 in Intestinal and Pancreatobiliary-Type Ampullary Carcinomas.

Introduction: The purpose of this study was to associate immunohistochemical expression of β-catenin, EGFR, CK7, CK20, MUC1, MUC2, and CDX2 in ampullary adenocarcinomas with the type of differentiation and prognosis. Methods: Forty-seven patients with ampullary adenocarcinoma who underwent pancreatoduodenectomy with curative intent from 1997 to 2014 were included in this study. Nine patients with perioperative death were included in the association analysis but excluded from survival analysis. All tumors were classified as intestinal or pancreatobiliary type, according to histologic criteria, and immunohistochemically stained against the aforementioned markers. Results: Eighteen carcinomas were classified as intestinal type and 29 carcinomas as pancreatobiliary type. Univariate analysis revealed that CK20 and CDX2 expression correlates with intestinal type, whereas MUC1 positivity indicates pancreatobiliary type. A marginally significant trend was shown for intestinal-type tumors toward larger size and more frequent MUC2 expression. Using multivariate analysis CK20 (P = .003) and MUC1 (P = .004) were identified as independent predictors of the intestinal and pancreatobiliary types, respectively. Mean and median survival was 90.3 and 55 months, respectively. Overall 5-year survival rate was 48%. On univariate survival analysis, overall survival was adversely influenced by the number of infiltrated lymph nodes, elevated Ca19-9 serum levels, jaundice, poor differentiation, T4 stage, N1 stage, TNM stage III, and CDX2 immunonegativity. Multivariate analysis identified TNM stage as the only independent prognostic factor in ampullary adenocarcinoma (P = .048). Conclusions: Immunoreactivity against CK20 and MUC1 in ampullary carcinomas is a useful adjunct to histologic examination in determining histotype. None of the immunohistochemical markers studied had prognostic significance.

Impact of CYP2D*6 in the adjuvant treatment of breast cancer patients with tamoxifen

Biotransformation of tamoxifen to the potent antiestrogen endoxifen is performed by cytochrome P450 (CYP) enzymes, in particular the CYP2D6 isoform. CYP2D6*4 is one of the most frequent alleles associated with loss of enzymatic activity. The incidence of CYP2D6*4 among Caucasians is estimated up to 27%, while it is present in up to 90% of all poor metabolizers within the Caucasian population. The hypothesis under question is whether the presence of one or two non-functioning (null) alleles predicts an inferior outcome in postmenopausal women with breast cancer receiving adjuvant treatment with tamoxifen. The numerous existing studies investigating the association of CYP2D6 with treatment failure in breast cancer are inconsistent and give rather conflicting results. Currently, routine CYP2D6 testing among women with breast cancer is not recommended and the significance of CYP2D6 phenotype in decision making regarding the administration of tamoxifen is unclear. The present study summarizes current literature regarding clinical studies on CYP2D6*4, particularly in terms of response to tamoxifen therapy and breast cancer outcome.