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Article ; Online: The European Society of Coloproctology: from the legend to the future.

Xynos, Evangelos

2022 Volume 74, Issue 1, Page(s) 7–9

MeSH term(s)	Colorectal Surgery ; Humans ; Societies, Medical
Language	English
Publishing date	2022-01-29
Publishing country	Italy
Document type	Editorial
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-01225-x
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Article ; Online: ESCP President's annual report 2020-2021.

Xynos, Evangelos

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 9, Page(s) 2225–2227

Language	English
Publishing date	2021-10-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15832
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Article: Functional results after surgery for obstructed defecation.

Xynos, Evaghelos

Acta chirurgica Iugoslavica

2013 Volume 59, Issue 2, Page(s) 25–29

Abstract: Obstructed defecation (OD) syndrome is associated with several abnormalities of the pelvic organs, namely anterior rectal mucosa prolapse, anterior rectocele, recto-anal intussusception, and a deep Douglas pouch which predisposes to enterocele or ... ...

Abstract	Obstructed defecation (OD) syndrome is associated with several abnormalities of the pelvic organs, namely anterior rectal mucosa prolapse, anterior rectocele, recto-anal intussusception, and a deep Douglas pouch which predisposes to enterocele or rectocele. Surgical repair of the anatomical deformities should be attempted, only after thorough selection of patients and conservative treatment has been exhausted. Transperineal procedures include resection-plication of the anterior rectal wall and stapled transanal rectal resection, and are indicated for the treatment of anterior rectocele and internal rectal prolapse. Functional results are satisfactory in approximately 75 percent of the cases. Transabdominal procedures include posterior prosthesis rectopexy, resection suture-rectopexy and ventral prosthesis colporectopexy. These procedures are indicated in patients with large rectocele and rectal intussusception and enterocele or sigmoidocele. The rate of repair of anatomical deformities is very high and improvement of symptoms is accounted in more than 80 percent of the cases. Ventral prosthesis colporectopexy seems a very promising approach, but further evidence is mandatory.
MeSH term(s)	Constipation/etiology ; Constipation/surgery ; Digestive System Surgical Procedures/methods ; Female ; Humans ; Intussusception/surgery ; Rectal Diseases/complications ; Rectal Diseases/surgery ; Rectal Prolapse/surgery ; Rectocele/surgery
Language	English
Publishing date	2013-02-01
Publishing country	Serbia
Document type	Journal Article ; Review
ZDB-ID	428721-6
ISSN	0354-950X ; 0001-5474
ISSN	0354-950X ; 0001-5474
DOI	10.2298/aci1202025x
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Article: Functional results after surgery for overt rectal prolaps.

Xynos, Evaghelos

Acta chirurgica Iugoslavica

2013 Volume 59, Issue 2, Page(s) 21–24

Abstract: Several procedures have been designed and applied to treat overt rectal prolapse (ORP). Transperineal procedures, such Altemeier and Delorme operations, are associated with less morbidity, but higher rate of recurrence and less optimal functional results. ...

Abstract	Several procedures have been designed and applied to treat overt rectal prolapse (ORP). Transperineal procedures, such Altemeier and Delorme operations, are associated with less morbidity, but higher rate of recurrence and less optimal functional results. Transabdominal procedures include a variety of rectopexies with the use of prosthesis or sutures and with or without resection of the redundant sigmoid colon. Nowadays, they are all approached by laparoscopy. Traditional prosthesis rectopexies repair ORP and improve incontinence, but are associated with increased rate of constipation. Resection sutuere-rectopexy seems to be associated with the best functional results, particular in patients with slow transit constipation and diverticular disease. More recently, prosthesis ventral coloporectopexy seems to be less invasive and to offer very satisfactory results.
MeSH term(s)	Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Humans ; Postoperative Complications ; Rectal Prolapse/surgery
Language	English
Publishing date	2013-02-01
Publishing country	Serbia
Document type	Journal Article ; Review
ZDB-ID	428721-6
ISSN	0354-950X ; 0001-5474
ISSN	0354-950X ; 0001-5474
DOI	10.2298/aci1202021x
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Article ; Online: Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis.

Manatakis, Dimitrios K / Gouvas, Nikolaos / Pechlivanides, George / Xynos, Evangelos

Updates in surgery

2021 Volume 74, Issue 1, Page(s) 11–21

Abstract: Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. ... ...

Abstract	Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
MeSH term(s)	Defecation ; Digestive System Surgical Procedures ; Female ; Humans ; Prostheses and Implants ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2021-10-19
Publishing country	Italy
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-01177-2
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Article ; Online: Elective surgery for conservatively treated acute uncomplicated diverticulitis: a systematic review of postoperative outcomes.

Gouvas, Nikolaos / Agalianos, Christos / Manatakis, Dimitrios K / Pechlivanides, George / Xynos, Evaghelos

Minerva surgery

2022 Volume 77, Issue 6, Page(s) 591–601

Abstract: Introduction: Elective surgery has been proposed, after at least two episodes of acute diverticulitis, initially treated conservatively, in order to prevent further episodes or chronic complaints. However, prophylactic surgery has been questioned, due ... ...

Abstract	Introduction: Elective surgery has been proposed, after at least two episodes of acute diverticulitis, initially treated conservatively, in order to prevent further episodes or chronic complaints. However, prophylactic surgery has been questioned, due to the associated risks of postoperative mortality and morbidity, as well as the risk of recurrent diverticulitis. This systematic review attempts to assess the role of prophylactic left colonic resection, after episodes of uncomplicated acute diverticulitis treated either conservatively with antibiotics and/or other supportive measures. Evidence acquisition: A systematic search was performed using Medline, Embase, Ovid, and Cochrane databases for studies reporting on the treatment of acute uncomplicated diverticulitis (Hinchey I). The main endpoint was treatment failure, defined as persistent/recurrent symptoms or need for readmission and/or reintervention. Secondary endpoints were the immediate postoperative outcomes. Evidence synthesis: In total, 24 studies with 2855 patients were included in the analysis. Intra- and postoperative complications rate were 5% and 16%, respectively. Anastomotic leak was 1.3% and emergency reoperation was 2.4%. Long-term symptomatic resolve was reported at 91%. Persistent or recurrent symptoms were observed in 5.4% of cases. Meta-analysis showed no significant difference in recurrence rates between surgical and conservative management. Conclusions: Elective surgery to prevent recurrent diverticulitis is not recommended, irrespective of the number of previous episodes. Generally, elective sigmoidectomy should not be recommended to patients with ongoing atypical lower abdominal symptoms after acute diverticulitis, but should aim primarily at improving quality of life. It should be offered to patients with ongoing inflammation, or diverticular complications.
MeSH term(s)	Humans ; Diverticulitis, Colonic/surgery ; Quality of Life ; Recurrence ; Diverticulitis/surgery ; Elective Surgical Procedures/adverse effects
Language	English
Publishing date	2022-11-04
Publishing country	Italy
Document type	Systematic Review ; Meta-Analysis ; Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.22.09726-X
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Article ; Online: Neo-adjuvant chemotherapy alone for the locally advanced rectal cancer: a systematic review.

Manatakis, Dimitrios K / Gouvas, Nikolaos / Souglakos, John / Xynos, Evangelos

International journal of clinical oncology

2020 Volume 25, Issue 9, Page(s) 1570–1580

Abstract: Neo-adjuvant chemoradiation (NA-CRT) is the standard of management for the locally advanced rectal cancer (LARC), achieving very low rates of local recurrence (LR). However, NA-CRT fails to control distant recurrence and improve survival, whilst it is ... ...

Abstract	Neo-adjuvant chemoradiation (NA-CRT) is the standard of management for the locally advanced rectal cancer (LARC), achieving very low rates of local recurrence (LR). However, NA-CRT fails to control distant recurrence and improve survival, whilst it is associated with increased postoperative morbidity and increased acute and late toxicity. In recent years, neo-adjuvant chemotherapy (NACTx) appears in the literature as an alternative to NA-CRT in patients with LARC. In the present study, the authors review all current evidence on the specific subject. Following a systematic search of the literature, 25 studies were identified reporting on short- or long-term outcomes of NACTx for LARC. Seventeen studies were prospective or retrospective series, and 8 comparative. Of the comparative studies, one was a randomized control trial (RCT) comparing NACTx to NA-CRT and to the combination of NACTx/NA-CRT, and another a non-randomized study comparing NACTx to NA-CRT. Chemotherapeutic regimens were 5-fluoropyrimidine and oxaliplatin based. In some of them, irinotecan or/and bevacizumab was added. A pooled analysis showed that NACTx is associated with a mean anastomotic leak rate of 6.8%. In the RCT, postoperative morbidity and overall toxicity was significantly less in the NACTx group. Mean T downstaging (ypStage 0-I) was 49.6%, mean N downstaging 69.6% and mean pathologic complete response (pCR) 10.7%. The RCT showed an inferior pCR rate after NACTx than after NA-CRT, but similar rates of T downstaging. Mean LR was 8.6% and mean distant recurrence 17.2%. Satisfactory survival rates are reported by several studies. NACTx seems to be an alternative to NA-CRT for patients with LARC, associated with low anastomotic leak, adequate tumour downstaging, low LR and rather high survival rates. Further data deriving from high-quality studies are necessary to assess safety and efficacy of NACTx as a substitute to NA-CRT, for at least a subset of patients with LARC.
MeSH term(s)	Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bevacizumab/administration & dosage ; Female ; Humans ; Irinotecan/administration & dosage ; Male ; Middle Aged ; Neoadjuvant Therapy/methods ; Neoplasm Recurrence, Local/drug therapy ; Oxaliplatin/administration & dosage ; Postoperative Complications/etiology ; Prospective Studies ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectum/pathology ; Retrospective Studies ; Survival Rate
Chemical Substances	Oxaliplatin (04ZR38536J) ; Bevacizumab (2S9ZZM9Q9V) ; Irinotecan (7673326042)
Language	English
Publishing date	2020-07-14
Publishing country	Japan
Document type	Journal Article ; Systematic Review
ZDB-ID	1400227-9
ISSN	1437-7772 ; 1341-9625
ISSN (online)	1437-7772
ISSN	1341-9625
DOI	10.1007/s10147-020-01738-2
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Article ; Online: Management of the adenocarcinoma of the upper rectum: a reappraisal.

Pechlivanides, George / Gourtsoyianni, Sophia / Gouvas, Nikolaos / Sougklakos, John / Xynos, Evangelos

Updates in surgery

2020 Volume 73, Issue 2, Page(s) 513–526

Abstract: The present review attempts to assess whether upper rectal cancer (URC) should be treated either as colon cancer or as rectal one, namely to be managed with upfront surgery without neo-adjuvant treatment and partial mesorectal excision (PME), or with neo- ...

Abstract	The present review attempts to assess whether upper rectal cancer (URC) should be treated either as colon cancer or as rectal one, namely to be managed with upfront surgery without neo-adjuvant treatment and partial mesorectal excision (PME), or with neo-adjuvant short course radiotherapy (SCRT) or chemoradiotherapy (CRT) as indicated, followed by surgery with total mesorectal excision. Reports from current evidence including studies, reviews and various guidelines are conflicting. Main reasons for inability to reach safe conclusions are (i) the various anatomical definitions of the rectum and its upper part, (ii) the inadequate preoperative local staging,(iii) the heterogeneity of selection criteria for the neo-adjuvant treatment,(iv) the different neo-adjuvant treatment regimens, and(v) the variety in the extent of surgical resection, among the studies. Although not adequately supported, locally advanced URC can be treated with neo-adjuvant CRT provided the lesion is within the radiation field of safety, and a PME if the lower border of the tumour is located above the anterior peritoneal reflection. There is evidence that adjuvant chemotherapy is of benefit in high-risk stage II and stage III lesions.
MeSH term(s)	Adenocarcinoma/pathology ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms/pathology ; Rectum/pathology ; Rectum/surgery ; Treatment Outcome
Language	English
Publishing date	2020-10-27
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00903-6
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Article: Primary curative surgery and preemptive or adjuvant hyperthermic peritoneal chemotherapy in colorectal cancer patients at high risk to develop peritoneal carcinomatosis. A systematic review.

Stamou, Konstantinos / Gouvas, Nikolaos / Pechlivanides, George / Xynos, Evaghelos

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

2018 Volume 23, Issue 5, Page(s) 1249–1261

Abstract: Purpose: Τo evaluate all available data on the effect of preemptive intervention in patients who have curative surgery for colorectal cancer (CRC) and are at high risk to develop peritoneal carcinomatosis (PC).: Methods: The authors conducted a ... ...

Abstract	Purpose: Τo evaluate all available data on the effect of preemptive intervention in patients who have curative surgery for colorectal cancer (CRC) and are at high risk to develop peritoneal carcinomatosis (PC). Methods: The authors conducted a systematic review of all published studies from January 2000 to July 2016. Twelve studies were eventually considered for analysis, and were divided in four categories, according to different approaches for adjuvant intra-peritoneal chemotherapy: a) hyperthermic intraperitoneal chemotherapy (HIPEC), during primary surgery for CRC; b) early postoperative intraperitoneal chemotherapy (EPIC), after primary surgery for CRC; c) early re-intervention (laparotomy or laparoscopy) and HIPEC; and d) as second look laparotomy and HIPEC + cytoreductive surgery (CRS), several months after primary surgery. Results: Considering prophylactic HIPEC during primary surgery, the studies that were analysed showed a peritoneal recurrence rate of 0-12.9%, a 3- and 5-year disease free survival (DFS) of 67-97.5% and 54.8-84% respectively, and a 3- and 5-year overall survival (OS) of 67-100% and 84%, respectively. These oncological results are probably better than what is expected in patients at high risk to develop PC and have only adjuvant systemic chemotherapy. Because of the great heterogeneity in inclusion criteria (risk factors for PC) and methodology of intra-peritoneal chemotherapy (different timing, different techniques, different agents), a meta-analysis was not performed. Conclusions: At present and because of the insufficient available evidence, preemptive intervention at the immediate postoperative adjuvant setting is recommended only in the setting of a registered clinical trial.
MeSH term(s)	Chemotherapy, Adjuvant ; Chemotherapy, Cancer, Regional Perfusion/methods ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Cytoreduction Surgical Procedures/methods ; Disease-Free Survival ; Humans ; Hyperthermia, Induced/methods ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/prevention & control ; Peritoneal Neoplasms/prevention & control ; Peritoneal Neoplasms/secondary ; Risk Factors
Language	English
Publishing date	2018-12-13
Publishing country	Greece
Document type	Journal Article ; Systematic Review
ZDB-ID	2040386-0
ISSN	2241-6293 ; 1107-0625
ISSN (online)	2241-6293
ISSN	1107-0625
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Article ; Online: Achieving a Textbook Outcome in Colon Cancer Surgery Is Associated with Improved Long-Term Survival.

Manatakis, Dimitrios K / Tzardi, Maria / Souglakos, John / Tsiaoussis, John / Agalianos, Christos / Kyriazanos, Ioannis D / Pechlivanides, George / Kordelas, Athanasios / Tasis, Nikolaos / Gouvas, Nikolaos / Xynos, Evaghelos

Current oncology (Toronto, Ont.)

2023 Volume 30, Issue 3, Page(s) 2879–2888

Abstract: Background: Colon cancer surgery is a complex clinical pathway and traditional quality metrics may exhibit significant variability between hospitals and healthcare providers. The Textbook Outcome (TO) is a composite quality marker capturing the fraction ...

Abstract	Background: Colon cancer surgery is a complex clinical pathway and traditional quality metrics may exhibit significant variability between hospitals and healthcare providers. The Textbook Outcome (TO) is a composite quality marker capturing the fraction of patients, in whom all desired short-term outcomes of care are realised. The aim of the present study was to assess the TO in a series of non-metastatic colon cancer patients treated with curative intent, with emphasis on long-term survival. Methods: Stage I-III colon cancer patients, who underwent curative colectomy following the Complete Mesocolic Excision principles, were retrospectively identified from the institutional database. TO was defined as (i) hospital survival, (ii) radical resection, (iii) no major complications, (iv) no reintervention, (v) no unplanned stoma and (vi) no prolonged hospital stay or readmission. Results: In total, 128 patients (male 61%, female 39%, mean age 70.7 ± 11.4 years) were included in the final analysis. Overall, 60.2% achieved a TO. The highest rates were observed for "hospital survival" and "no unplanned stoma" (96.9% and 97.7%), while the lowest rates were for "no major complications" and "no prolonged hospital stay" (69.5% and 75%). Older age, left-sided resections and pT4 tumours were factors limiting the chances of a TO. The 5-year overall and 5-year cancer-specific survival were significantly better in the TO versus non-TO subgroup (81% vs. 59%, Conclusions: Outcomes in colon cancer surgery may be affected by patient-, doctor- and hospital-related factors. TO represents those patients who achieve the optimal perioperative results, and is furthermore associated with improved long-term cancer survival.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Colonic Neoplasms/surgery ; Colonic Neoplasms/pathology ; Colectomy/adverse effects ; Colectomy/methods ; Mesocolon/pathology ; Mesocolon/surgery
Language	English
Publishing date	2023-02-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol30030220
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