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Article ; Online: Iron Deficiency Anemia in Colorectal Cancer Patients: Is Preoperative Intravenous Iron Infusion Indicated? A Narrative Review of the Literature.

Chardalias, Leonidas / Papaconstantinou, Ioannis / Gklavas, Antonios / Politou, Marianna / Theodosopoulos, Theodosios

Cancer diagnosis & prognosis

2023 Volume 3, Issue 2, Page(s) 163–168

Abstract: Iron deficiency anemia is the most common extraintestinal symptom in patients with colorectal cancer (CRC). Inflammation associated with malignancy leads to functional iron deficiency via the hepcidin pathway, whereas chronic blood loss causes absolute ... ...

Abstract	Iron deficiency anemia is the most common extraintestinal symptom in patients with colorectal cancer (CRC). Inflammation associated with malignancy leads to functional iron deficiency via the hepcidin pathway, whereas chronic blood loss causes absolute iron deficiency and depletion of iron stores. The assessment and treatment of preoperative anemia is of great importance in patients with CRC, since published data have consistently shown that preoperative anemia is associated with increased need for perioperative blood transfusions and more postoperative complications. Recent studies have documented mixed results regarding the preoperative intravenous iron administration in anemic CRC patients in terms of efficacy for anemia correction, cost-effectiveness, need for transfusions and risk for postoperative complications.
Language	English
Publishing date	2023-03-03
Publishing country	Greece
Document type	Journal Article ; Review
ISSN	2732-7787
ISSN (online)	2732-7787
DOI	10.21873/cdp.10196
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Article: Risk factors for postoperative complications after elective ileocolic resection for Crohn's disease: a retrospective study.

Gklavas, Antonios / Poulaki, Aikaterini / Dellaportas, Dionysios / Papaconstantinou, Ioannis

Annals of gastroenterology

2020 Volume 33, Issue 6, Page(s) 645–655

Abstract: Background: The incidence of postoperative complications (POC) in patients with Crohn's disease (CD) who undergo intestinal resection is high. The literature provides conflicting data about the risk factors for POC, especially regarding preoperative ... ...

Abstract	Background: The incidence of postoperative complications (POC) in patients with Crohn's disease (CD) who undergo intestinal resection is high. The literature provides conflicting data about the risk factors for POC, especially regarding preoperative immunosuppressive medications. The purpose of this study was to evaluate the impact of anti-tumor necrosis factor (TNF) agents on the postoperative course and identify other predictors for POC after ileocolic resection (ICR). Methods: This was a single-center retrospective study that included 153 CD patients who underwent elective ICR in a Greek tertiary center between January 2010 and December 2018. Risk factors for overall POC and intra-abdominal septic complications (IASC) were assessed with univariate and multivariate analyses. Results: Overall POC and IASC occurred in 35 (22.9%) and 19 (12.4%) patients, respectively. In multivariate analysis, anti-TNF agents (n=61), as either monotherapy or combination treatment, were not associated with an increased risk for overall POC (21.3% vs. 23.9%, P=0.71) or IASC (13.1% vs. 12.0%, P=0.83). Similarly, no combined immunosuppressive regimen significantly correlated with POC. Patients with perianal disease, disease duration >10 years, or previous intestinal resections had significantly higher rates of both overall POC and IASC. In multivariate analysis, previous resection was the only independent risk factor for overall POC (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.38-11.06; P=0.010) and IASC (OR 4.56, 95%CI 1.51-13.77; P=0.007). Conclusions: Preoperative administration of anti-TNF agents or other immunosuppressive regimens was not a risk factor for total POC or IASC. A history of previous resection independently correlated with both overall POC and IASC.
Language	English
Publishing date	2020-09-16
Publishing country	Greece
Document type	Journal Article
ZDB-ID	2032850-3
ISSN	1108-7471
ISSN	1108-7471
DOI	10.20524/aog.2020.0533
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Article ; Online: Specific Neuropeptide Expression in Crohn's Disease Ileocolonic Resection Specimens Is Not Associated with Plexitis at the Ileal Margin or Postoperative Recurrence.

Gklavas, Antonios / Tiniakos, Dina / Karandrea, Despoina / Karamanolis, George / Bamias, Giorgos / Papaconstantinou, Ioannis

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2022 Volume 26, Issue 4, Page(s) 887–899

Abstract: Background: Myenteric plexitis is considered a risk factor for postoperative recurrence (POR) in Crohn's disease (CD). The primary purpose of this study was to evaluate the association between neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), ... ...

Abstract	Background: Myenteric plexitis is considered a risk factor for postoperative recurrence (POR) in Crohn's disease (CD). The primary purpose of this study was to evaluate the association between neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), and substance P (SP) expression and plexitis at the proximal resection margin. The secondary aim was to identify risk factors for POR. Methods: A retrospective, single-center study on CD patients who underwent ileocolonic resection (ICR) between January 2010 and December 2016 was conducted. The presence and severity of plexitis were evaluated by hematoxylin and eosin stain. Mast cells were highlighted by Giemsa stain. Immunohistochemistry was used to identify T lymphocytes and NPY-, VIP-, and SP-ergic neurons. Neuropeptide expression was quantified using image analysis. Results: Seventy-nine patients were included. No association was detected between NPY, VIP, and SP expression and plexitis. Similarly, the number of involved inflammatory cells, T lymphocytes or mast cells was not correlated with neuropeptide expression. Smoking (hazard ratio [HR] 4.07; 95% confidence interval [CI] 2.08-7.94; p < 0.001), moderate (HR 3.68; 95%CI 1.06-12.73; p = 0.040), and severe myenteric plexitis (HR 7.36; 95%CI 1.12-48.30; p = 0.037) were independent risk factors for endoscopic POR, whereas smoking (HR 2.78; 95%CI 1.01-7.67; p = 0.049), severe myenteric plexitis (HR 20.03; 95%CI 1.09-368.28; p = 0.044), and involved ileal margin (HR 3.45; 95%CI 1.33-8.96; p = 0.011) for clinical POR. Conclusions: Smoking, moderate or severe myenteric plexitis, and involved ileal margin negatively affect POR in CD patients undergoing ICR. Submucosal and myenteric plexitis at the proximal resection margin is not related to the expression of specific neuropeptides.
MeSH term(s)	Crohn Disease/complications ; Crohn Disease/surgery ; Humans ; Ileum/surgery ; Margins of Excision ; Neoplasm Recurrence, Local/complications ; Neuropeptides ; Prognosis ; Recurrence ; Retrospective Studies
Chemical Substances	Neuropeptides
Language	English
Publishing date	2022-01-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-021-05215-7
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Is the Quality of Life of Patients with Fistulizing Perianal Crohn' s Disease Impaired by the Presence of Chronic Loose, Non-cutting Seton?

Gklavas, Antonios / Sotirova, Ira / Karageorgou, Margarita / Kozonis, Theodoros / Poulaki, Aikaterini / Papaconstantinou, Ioannis

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2021 Volume 25, Issue 10, Page(s) 2686–2689

MeSH term(s)	Drainage ; Humans ; Infliximab ; Quality of Life ; Rectal Fistula/etiology ; Treatment Outcome
Chemical Substances	Infliximab (B72HH48FLU)
Language	English
Publishing date	2021-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-021-04987-2
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Article: Quality of life of ulcerative colitis patients treated surgically with proctocolectomy and J-pouch formation: a comparative study before surgery and after closure of the defunctioning ileostomy.

Exarchos, Georgios / Gklavas, Antonios / Metaxa, Linda / Papaconstantinou, Ioannis

Annals of gastroenterology

2018 Volume 31, Issue 3, Page(s) 350–355

Abstract: Background: Ulcerative colitis (UC) is a lifelong disease with a relapse-remission pattern that affects patients' social and psychological wellbeing. Restorative proctocolectomy and J-pouch formation is the gold-standard surgical procedure in cases ... ...

Abstract	Background: Ulcerative colitis (UC) is a lifelong disease with a relapse-remission pattern that affects patients' social and psychological wellbeing. Restorative proctocolectomy and J-pouch formation is the gold-standard surgical procedure in cases where symptoms are refractory to currently available medical treatment. The aim of this study was to assess patients' quality of life (QoL) in order to evaluate the efficiency of surgery and patients' symptomatology. Methods: We performed a prospective comparative study of the QoL of 47 patients with UC, treated surgically. As research tools, we used the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Cleveland Global Quality of Life (CGQL) questionnaire. Parametric and non-parametric tests were used in order to correlate areas of QoL and other selected factors, such as marital status, sex, age, and education. Results: The mean scores before and after closure of the ileostomy were 153.29 and 178 for the IBDQ (P=0.0025), and 17.4 and 23.42 for the CGQL (P<0.001), suggesting an overall improvement in QoL. The research showed that there was no specific QoL factor, such as intestinal, systemic, emotional or social life symptoms, that improved significantly more than the others (P=0.99). The IBDQ showed that patients aged less than 20 years (P<0.001), female patients (P=0.03) and patients with secondary education (P<0.001) reported the greatest improvement. Conclusions: The QoL in UC patients treated surgically improved following closure of the de-functioning ileostomy. QoL studies are encouraged to optimize and maintain high standards of surgical care, and they could potentially be used for assessment of therapeutic efficacy.
Language	English
Publishing date	2018-03-15
Publishing country	Greece
Document type	Journal Article
ZDB-ID	2032850-3
ISSN	1108-7471
ISSN	1108-7471
DOI	10.20524/aog.2018.0247
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Article: Liver metastasectomy-cytoreductive surgery- hyperthermic intraperitoneal chemotherapy and ileal pouch-anal anastomosis: A case report.

Chardalias, Leonidas / Gklavas, Antonios / Sotirova, Ira / Vlachou, Erasmia / Kontis, John / Papaconstantinou, Ioannis

International journal of surgery case reports

2020 Volume 72, Page(s) 397–401

Abstract: Introduction: Cytoreductive surgery (CRS) with hyperthermal intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal carcinomatosis that prolong survival in carefully selected patients. At the time of diagnosis, 4-7% of patients ... ...

Abstract	Introduction: Cytoreductive surgery (CRS) with hyperthermal intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal carcinomatosis that prolong survival in carefully selected patients. At the time of diagnosis, 4-7% of patients with colorectal cancer (CRC) have metastasis to the peritoneum. There is a lack of evidence in the literature if J-pouch can be applied simultaneously with HIPEC to improve quality of life in patients with familial adenomatous polyposis syndrome (FAP) and peritoneal carcinomatosis. Case presentation: We describe a case of a 41-year-old Caucasian male with Familial Adenomatous Polyposis which was diagnosed as metastatic colorectal cancer in the liver and peritoneum. He was treated with systemic chemotherapy followed by total proctocolectomy with a J-shaped IPAA, liver metastasectomy, right hemidiaphragm resection, CRS and HIPEC. Discussion: CRS and HIPEC have been implicated with high morbidity and mortality rates. A major independent risk factor correlated with high morbidity is anastomotic failure. J-Pouch formation although considered a technique with high complication rates, improves the quality of life of patients after total proctocolectomy and is related to high patient satisfaction. There are inconclusive data on whether anastomotic failure rates are higher when performing J-Pouch and HIPEC together. Conclusions: J-Pouch after CRS and HIPEC can be offered as a treatment as long as the patient is carefully selected, in high volume centers with experienced surgeons.
Language	English
Publishing date	2020-06-13
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.06.055
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Article ; Online: Multiple Small Bowel Diverticula Were an Unexpected Finding During Laparoscopic Enterectomy for Crohn's Disease.

Sotirova, Ira / Gklavas, Antonios / Papalouka, Dimitra / Gourtsoyianni, Sofia / Christodoulou, Dimitrios / Papaconstantinou, Ioannis

Medical archives (Sarajevo, Bosnia and Herzegovina)

2020 Volume 74, Issue 2, Page(s) 142–145

Abstract: Introduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn's ... ...

Abstract	Introduction: Small bowel diverticulosis (SBD) is a rare entity. Although it is usually an asymptomatic condition, clinical manifestations may vary from non-specific clinical signs to severe and complicated disease. The coexistence of SBD and Crohn's disease (CD) is rarely reported in the current literature. Aim: We present a rare case of concomitant Crohn's disease (CD) and SBD in a male patient, where multiple jejunal diverticula were an incidental intraoperative finding. Preoperative evaluation with magnetic resonance enterography (MRE) failed to recognize the coexistence of these two entities. Surgeons should be aware of the possibility of this rare situation. Case report: A 52-year-old Caucasian male diagnosed with CD was referred to our department for surgical intervention due to an ileal stricture. The patient reported no past medical history, except for a few episodes of bloody diarrhoea during a three-year period. The index colonoscopy revealed luminal narrowing in the ileum at approximately 70 cm proximal to the ileocaecal valve, and biopsies revealed findings compatible with CD. Clinical examination and laboratory tests were unremarkable one day before surgery. The patient underwent laparoscopic segmental resection of the affected part of the ileum. Intraoperatively, multiple non-inflamed diverticula along the jejunum extending from the Treitz ligament to the proximal ileum were recognized. Our patient had an uncomplicated post-operative course and was discharged on the fifth post-operative day. Pathological examination revealed features compatible with CD in the active phase. The patient was referred to his gastroenterological team for further consultation regarding the appropriate post-operative management. Conclusion: Concomitant CD and SBD is a rare condition, and the differential diagnosis may be challenging due to overlapping symptoms.
MeSH term(s)	Constriction, Pathologic ; Crohn Disease/complications ; Crohn Disease/diagnostic imaging ; Crohn Disease/surgery ; Diverticulum/complications ; Diverticulum/diagnosis ; Humans ; Ileal Diseases/complications ; Ileal Diseases/diagnostic imaging ; Ileal Diseases/surgery ; Incidental Findings ; Intestine, Small/abnormalities ; Jejunal Diseases/complications ; Jejunal Diseases/diagnosis ; Laparoscopy ; Magnetic Resonance Imaging ; Male ; Middle Aged
Language	English
Publishing date	2020-06-24
Publishing country	Bosnia and Herzegovina
Document type	Case Reports
ZDB-ID	128782-5
ISSN	1986-5961 ; 0025-8083 ; 0350-199X
ISSN (online)	1986-5961
ISSN	0025-8083 ; 0350-199X
DOI	10.5455/medarh.2020.74.142-145
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Article ; Online: Comparison of the laparoscopic versus open surgery in patients aged over 75 years old with colorectal cancer. Short- and Mid-term outcomes.

Sotirova, Ira / Gklavas, Antonios / Nastos, Constantinos / Micha, Georgia / Dafnios, Nikolaos / Dellaportas, Dionysios / Theodosopoulos, Theodosios

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

2020 Volume 25, Issue 5, Page(s) 2186–2191

Abstract: Purpose: The benefit of minimally invasive surgery in colorectal cancer patients has been established, however it is not clear whether these advantages apply to older patients as well. The aim of this study was to review short- and mid-term outcomes in ... ...

Abstract	Purpose: The benefit of minimally invasive surgery in colorectal cancer patients has been established, however it is not clear whether these advantages apply to older patients as well. The aim of this study was to review short- and mid-term outcomes in elderly patients, over the age of 75 years, with colorectal cancer. Methods: This was a retrospective study of selected patients over the age of 75 who underwent laparoscopic and open surgery for colorectal cancer between February 2013 and January 2018 in a tertiary referral center. All patients were categorized in two groups: Group 1 included patients who had open procedure (OP) and Group 2 those who underwent laparoscopic procedure (LP). Demographic, clinical, short- and midterm postoperative data were collected and analyzed between the two study groups. Results: A total of 78 patients were included in our cohort; 39 (50%) were operated with LP. The LP was equally safe in comparison with the OP, considering the similar postoperative complications [9 patients (34.6%) in LP and 5 patients (18.5%) in OP (p=0.224)], including anastomotic leakage in 2 patients (7.7%) in LP and 1 patient (3.7%) in OP group (p=0.61). The median postoperative hospital stay favored the laparoscopic approach (6 days in LP group and 8 days in OP group; p=0.001). The number of harvested lymph nodes were without statistically significant differences [LP group retrieved 20.0 nodes in comparison with 20.5 nodes in OP group (p= 0.816)]. The overall survival analysis showed no difference between the two approaches in 12 and 24 postoperative months (p=0.098 and 0.387, respectively).
MeSH term(s)	Aged ; Aged, 80 and over ; Colectomy/methods ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Female ; Humans ; Laparoscopy/methods ; Male ; Postoperative Complications ; Treatment Outcome
Language	English
Publishing date	2020-12-10
Publishing country	Greece
Document type	Journal Article
ZDB-ID	2040386-0
ISSN	2241-6293 ; 1107-0625
ISSN (online)	2241-6293
ISSN	1107-0625
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Article: Risk factors for postoperative recurrence of Crohn's disease with emphasis on surgical predictors.

Gklavas, Antonios / Dellaportas, Dionysios / Papaconstantinou, Ioannis

Annals of gastroenterology

2017 Volume 30, Issue 6, Page(s) 598–612

Abstract: Intestinal resection for Crohn's disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early ... ...

Abstract	Intestinal resection for Crohn's disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the "gold standard" procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.
Language	English
Publishing date	2017-09-26
Publishing country	Greece
Document type	Journal Article ; Review
ZDB-ID	2032850-3
ISSN	1108-7471
ISSN	1108-7471
DOI	10.20524/aog.2017.0195
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Article ; Online: Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?

Exarchos, Georgios / Metaxa, Linda / Gklavas, Antonios / Koutoulidis, Vassilis / Papaconstantinou, Ioannis

European radiology

2018 Volume 29, Issue 4, Page(s) 1754–1761

Abstract: Objectives: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the "gold standard" procedure for patients with ulcerative colitis (UC) requiring surgical intervention. A de-functioning ileostomy is usually performed, as a step for ... ...

Abstract	Objectives: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the "gold standard" procedure for patients with ulcerative colitis (UC) requiring surgical intervention. A de-functioning ileostomy is usually performed, as a step for the IPAA procedure. The aim of this study is to present the methodology and results of the routine double assessment of IPAA integrity in asymptomatic patients prior to the ileostomy reversal and evaluate its necessity. Methods: This is a retrospective study of 61 UC patients, who underwent IPAA construction, in 2010-2016. A diverting ileostomy was created after IPAA construction, which was reversed at least 3 months later. A double assessment, with pouchogram and pouchoscopy, of IPAA integrity was performed, before stoma closure. Post-operative symptoms and signs of complications, imaging studies, and endoscopic findings were recorded during follow-up. Results: Prior to the ileostomy reversal, both pouchoscopy and pouchogram identified no patient with evidence of anastomotic leakage. During a mean follow-up of 3.67 years after ileostomy reversal, 11 patients developed complications but only one had signs of leakage, which presented as a pouch-vaginal fistula. The specificity of both the pouchogram and pouchoscopy reached 100% and the negative predictive value ranged between 98.4 and 100%. Conclusions: The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis, but their combination did not alter the diagnostic accuracy or had any effect in further management. At least, pouchogram could be selectively performed only in patients with high-risk clinical indicators. Key points: • The double assessment of ileal pouch-anal anastomosis with pouchogram and pouchoscopy, prior to ileostomy closure, specifically in patients with ulcerative colitis has not been evaluated before. • The specificity of pouchoscopy and pouchogram prior to ileostomy closure, in asymptomatic patients with IPAA for UC, is very high in recognizing an intact anastomosis. • However, their combination did not alter the diagnostic accuracy or had any effect in further management, in asymptomatic patients.
MeSH term(s)	Adolescent ; Adult ; Aged ; Anastomotic Leak/diagnostic imaging ; Colitis, Ulcerative/surgery ; Colonic Pouches ; Endoscopy, Gastrointestinal/methods ; Female ; Fluoroscopy/methods ; Humans ; Ileostomy/methods ; Male ; Middle Aged ; Postoperative Complications/diagnostic imaging ; Preoperative Care/methods ; Proctocolectomy, Restorative/methods ; Retrospective Studies ; Sensitivity and Specificity ; Young Adult
Language	English
Publishing date	2018-10-15
Publishing country	Germany
Document type	Evaluation Study ; Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-018-5760-0
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