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Article ; Online: Letter to the Editor on the article "Predictors of acute diverticulitis severity: A systematic review".

Kechagias, Aristotelis

International journal of surgery (London, England)

2016 Volume 28, Page(s) 69–70

MeSH term(s)	Acute Disease ; C-Reactive Protein ; Diverticulitis ; Diverticulitis, Colonic ; Humans
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2016-04
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2016.02.067
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Article ; Online: Papillary thyroid carcinoma micro-deposits in cervical lymph nodes without intra-thyroid malignancy: A comment in consideration of the latest American Thyroid Association guidelines.

Karvounis, Evangelos / Kechagias, Aristotelis / Kappas, Ioannis / Ioakimidou, Christina / Fillipidis, Theodoros

Molecular and clinical oncology

2021 Volume 15, Issue 2, Page(s) 164

Abstract: Differentiated thyroid cancer (DTC) represents the vast majority of all thyroid cancers, with the papillary variant being the most common. According to the previous 2009 American Thyroid Association (ATA) guidelines, papillary thyroid microcarcinoma ( ... ...

Abstract	Differentiated thyroid cancer (DTC) represents the vast majority of all thyroid cancers, with the papillary variant being the most common. According to the previous 2009 American Thyroid Association (ATA) guidelines, papillary thyroid microcarcinoma (PTMC; ≤1 cm in diameter) exhibiting cervical lymph node metastasis corresponded to an intermediate-risk group for recurrence or metastasis. However, the latest 2015 ATA guidelines advocate that a patient with PTMC is low-risk if there are ≤5 regional node micrometastases. This means that therapeutic radioactive iodine (RAI) is not required. The current study reports a rare case of a patient who underwent total thyroidectomy due to multi-nodular goiter where the pathologic specimen exhibited two PTMC foci in regional lymph nodes, but no primary cancer was identified in the thyroid despite thorough examination of the thyroid parenchyma. The etiology of such results is unknown and it was hypothesized that it may be the consequence of insufficient pathologic examination or due to the regression of a primary PTMC in the thyroid. Moreover, the risk-stratification of cases with intra-lymph node PTMC without any evidence of primary cancer in the thyroid is not considered in the ATA recommendations. The aim of the current report was to elucidate the risk-stratification of this rare occurrence and to reconsider the possible etiologies. By extrapolating the latest ATA recommendations concerning a patient with a known primary PTMC and ≤5 metastatic micro-foci (thus the only difference between cases being the absence of a primary tumor), it was concluded that the patient should be considered low-risk. As a consequence, RAI therapy should be deemed as unnecessary despite the presence of lymph node microfoci. Moreover, it was proposed that cervical lymph node PTMC with no evidence of a primary tumor in the thyroid could be the consequence of normal thyroid tissue micro-deposit progression to cancer within the lymph node, which is a rare benign entity.
Language	English
Publishing date	2021-06-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2796865-0
ISSN	2049-9469 ; 2049-9450
ISSN (online)	2049-9469
ISSN	2049-9450
DOI	10.3892/mco.2021.2326
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Article ; Online: Immediate effects of urgent reorganisation of emergency department-based treatment pathway in nonperforated appendicitis: a retrospective study.

Ojakäär, Artur / Purdy, Martin / Kechagias, Aristotelis / Järvelin, Ulla / Palomäki, Ari

BMC emergency medicine

2020 Volume 20, Issue 1, Page(s) 45

Abstract: Background: Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called ... ...

Abstract	Background: Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. Postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess, whether this reorganisation was feasible and safe, i.e. did it affect the length of in-hospital stay (LOS) and the 30-day complication rate. Methods: This is a retrospective pre- and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-h observation unit of the ED instead of surgical ward. Patients operated during the first 3 months after the reorganisation were compared to those operated during the 3 months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age < 18 years and perforated disease. Results: Appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 h for all patients after the reorganisation compared to 24.4 h before the reorganisation (standard error 6.2 h, 95% confidence interval 2.3-15.2 h, p < 0.01). There were no more complications in the group treated postoperatively in the ED. Conclusions: Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED - instead of the surgical ward - occurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.
MeSH term(s)	Adult ; Aged ; Appendectomy ; Appendicitis/surgery ; Critical Pathways/organization & administration ; Emergency Service, Hospital/organization & administration ; Female ; Finland/epidemiology ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Discharge/statistics & numerical data ; Postoperative Complications/epidemiology ; Retrospective Studies
Language	English
Publishing date	2020-05-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-227X
ISSN (online)	1471-227X
DOI	10.1186/s12873-020-00339-6
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Article ; Online: Splenohepatic sarcoidosis 12 years after breast cancer curative surgery: a diagnostic dilemma in imaging.

Pengermä, Pasi / Katunin, Jevgeni / Turunen, Arto / Palomäki, Ari / Kechagias, Aristotelis

ANZ journal of surgery

2020 Volume 90, Issue 12, Page(s) E221–E222

MeSH term(s)	Breast Neoplasms/surgery ; Diagnostic Imaging ; Humans ; Sarcoidosis/diagnostic imaging
Language	English
Publishing date	2020-06-03
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.16017
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Article: Appendiceal perforation due to biliary stent migration in a neutropenic patient with lung cancer receiving chemotherapy: A case report.

Pengermä, Pasi / Katunin, Jevgeni / Turunen, Arto / Sileri, Pierpaolo / Giarratano, Gabriella / Palomäki, Ari / Kechagias, Aristotelis

Molecular and clinical oncology

2021 Volume 15, Issue 1, Page(s) 136

Abstract: The use of biliary stents has become a common and usually safe procedure. However, the migration of biliary stents is an uncommon but well-recognized event after endoscopic retrograde cholangiopancreatography. The migration of plastic stents usually does ...

Abstract	The use of biliary stents has become a common and usually safe procedure. However, the migration of biliary stents is an uncommon but well-recognized event after endoscopic retrograde cholangiopancreatography. The migration of plastic stents usually does not result in complications and are spontaneously eliminated from the gastro-intestinal tract. Additionally, <1% of migrated stents result in intestinal perforation, which typically occurs at the duodenum. Chemotherapeutic agents may cause gastrointestinal toxicity and hematologic toxicity predisposing to neutropenic enterocolitis. The current study reports a patient with an unprecedented case of biliary stent migration resulting in appendiceal gangrene and perforation in a neutropenic patient under chemotherapy for metastatic small cell lung cancer.
Language	English
Publishing date	2021-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2796865-0
ISSN	2049-9469 ; 2049-9450
ISSN (online)	2049-9469
ISSN	2049-9450
DOI	10.3892/mco.2021.2298
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Article: Presentation of gastroesophageal junction adenocarcinoma with synchronous metastases at the small intestine. Could treatment with curative intent be considered? A case report.

Huang, Biying / Kechagias, Aristotelis / Tsekrekos, Andrianos / Lovece, Andrea / Hayami, Masaru / Rouvelas, Ioannis

International journal of surgery case reports

2021 Volume 84, Page(s) 106164

Abstract: Introduction: Introduction of multimodality treatment as the standard of care for management of esophageal and gastroesophageal junction (GEJ) cancer over the last years has led to significant improvement in survival for patients with localized disease. ...

Abstract	Introduction: Introduction of multimodality treatment as the standard of care for management of esophageal and gastroesophageal junction (GEJ) cancer over the last years has led to significant improvement in survival for patients with localized disease. Nevertheless, treatment with curative intent is not considered in the case of metastatic disease. We report a case of a locally advanced GEJ adenocarcinoma with solitary resectable synchronous metastases at the jejunum and a good response to neoadjuvant therapy followed by esophagectomy with curative intention. Case presentation: This is the case of a patient with poorly differentiated adenocarcinoma of the GEJ with synchronous metastases at the jejunum. The patient underwent extensive work-up including PET-CT. The metastases at the jejunum were completely resected during an initial staging laparoscopy and there was no evidence of further metastatic disease. The patient received chemotherapy and re-staging showed remarkable tumor response. Esophagectomy with curative intent was performed. Histopathology showed complete pathologic response after chemotherapy. Although our patient had a stage IV disease at presentation, he remained metastasis-free for a significant period of time, with no evidence of any distant recurrence during a follow-up of 16 months after esophagectomy. Discussion and conclusions: Synchronous metastasis to the small bowel from an esophageal carcinoma is a rare entity. Routine PET-CT in addition to conventional CT may assist in more precise staging of a patient with resectable disease. Stage IV esophageal cancer with limited and resectable metastatic disease and good tumor response to oncological therapy may be considered for treatment with potentially curative intent.
Language	English
Publishing date	2021-06-30
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2021.106164
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Article ; Online: Is surgical exploration mandatory in pneumatosis intestinalis with portomesenteric gas? Lesson learned in a neutropenic patient under chemotherapy.

Pengermä, Pasi / Katunin, Jevgeni / Turunen, Arto / Rouvelas, Ioannis / Palomäki, Ari / Kechagias, Aristotelis

ANZ journal of surgery

2021 Volume 92, Issue 3, Page(s) 543–545

MeSH term(s)	Humans ; Mesenteric Veins ; Pneumatosis Cystoides Intestinalis/chemically induced ; Pneumatosis Cystoides Intestinalis/diagnostic imaging ; Portal Vein
Language	English
Publishing date	2021-06-25
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17043
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Article ; Online: Pericolic or paracolic? The right word in the right place for acute diverticulitis.

Kechagias, Aristotelis / Palomäki, Ari / Dervenis, Christos / Triantopoulou, Charikleia

European radiology

2018 Volume 29, Issue 8, Page(s) 4377–4378

Abstract: Key point: • The term "pericolic" is wrongly used to describe an abscess adjacent to the colon in patients with acute diverticulitis. We explain why the proper term is the word "paracolic." ...

Abstract	Key point: • The term "pericolic" is wrongly used to describe an abscess adjacent to the colon in patients with acute diverticulitis. We explain why the proper term is the word "paracolic."
MeSH term(s)	Abscess/pathology ; Acute Disease ; Colonic Diseases/pathology ; Diverticulitis, Colonic/pathology ; Humans ; Terminology as Topic
Language	English
Publishing date	2018-12-03
Publishing country	Germany
Document type	Letter
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-018-5827-y
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Article: Role of Radiology in the Preoperative Detection of Arterial Calcification and Celiac Trunk Stenosis and Its Association with Anastomotic Leakage Post Esophagectomy, an Up-to-Date Review of the Literature.

Tzortzakakis, Antonios / Kalarakis, Georgios / Huang, Biying / Terezaki, Eleni / Koltsakis, Emmanouil / Kechagias, Aristotelis / Tsekrekos, Andrianos / Rouvelas, Ioannis

Cancers

2022 Volume 14, Issue 4

Abstract: Surgical resection of the esophagus remains a critical component of the multimodal treatment of esophageal cancer. Anastomotic leakage (AL) is the most significant complication following esophagectomy, in terms of clinical implications. Identifying risk ... ...

Abstract	Surgical resection of the esophagus remains a critical component of the multimodal treatment of esophageal cancer. Anastomotic leakage (AL) is the most significant complication following esophagectomy, in terms of clinical implications. Identifying risk factors for AL is important for modifying patient management and improving surgical outcomes. This review aims to examine the role of radiological risk factors for AL after esophagectomy, and in particular, arterial calcification and celiac trunk stenosis. Eligible publications prior to 25 August 2021 were retrieved from Medline and Google Scholar using a predefined search algorithm. A total of 68 publications were identified, of which 9 original studies remained for in-depth analysis. The majority of these studies found correlations between calcifications in the aorta, celiac trunk, and right post-celiac arteries and AL following esophagectomy. Some studies suggest celiac trunk stenosis as a more appropriate surrogate. Our up-to-date review highlights the need for automated quantification of aortic calcifications, as well as the degree of celiac trunk stenosis in preoperative computed tomography in patients undergoing esophagectomy, to obtain robust and reproducible measurements that can be used for a definite correlation.
Language	English
Publishing date	2022-02-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14041016
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Article ; Online: Venous thromboembolism after esophagectomy for cancer: a systematic review of the literature to evaluate incidence, risk factors, and prophylaxis.

Theochari, Nikoletta A / Theochari, Christina A / Kokkinidis, Damianos G / Kechagias, Aristotelis / Lyros, Orestis / Giannopoulos, Stefanos / Mantziari, Styliani / Schizas, Dimitrios

Surgery today

2021 Volume 52, Issue 2, Page(s) 171–181

Abstract: Purpose: Although esophagectomy remains the preferred treatment for esophageal cancer, it is still associated with a number of complications, including post-operative venous thromboembolism (VTE). The aim of this study was to summarize the reported ... ...

Abstract	Purpose: Although esophagectomy remains the preferred treatment for esophageal cancer, it is still associated with a number of complications, including post-operative venous thromboembolism (VTE). The aim of this study was to summarize the reported incidence of VTE after esophagectomy, its risk factors, and prevention strategies. Methods: We conducted a systematic search of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Fourteen studies met our inclusion criteria and were selected in the present review. Overall, we identified 9768 patients who underwent esophagectomy, with a post-operative VTE rate of 4% (440 patients). The reported risk factors for VTE included advanced age, American Society of Anesthesiologists (ASA) class III or IV, a history of cardiovascular or pulmonary disease, and the implementation of preoperative chemo-radiotherapy. Postoperative acute respiratory distress syndrome was also associated with VTE. No universally applied prevention strategies for VTE after esophagectomy were identified in the literature. Conclusions: Despite advances in perioperative care, VTE after esophagectomy still represents a source of morbidity for about 4% of patients. Low molecular weight heparin is suggested as the routine standard prophylactic regimen after esophageal cancer surgery.
MeSH term(s)	Aged ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Risk Factors ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
Language	English
Publishing date	2021-03-13
Publishing country	Japan
Document type	Journal Article ; Systematic Review
ZDB-ID	1115435-4
ISSN	1436-2813 ; 0941-1291
ISSN (online)	1436-2813
ISSN	0941-1291
DOI	10.1007/s00595-021-02260-2
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