Maria A Kyriazi

Publications (17) View all

• Article: Should Diaphragmatic Involvement Preclude Resection of Large Hepatic Tumors?

  Nikolaos Arkadopoulos, Maria A Kyriazi, Apostolos Perelas, Kassiani Theodoraki, Evangelia Papantoni, Panagiotis Kokoropoulos, Nikolaos Danias, Vassilios Smyrniotis
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  ABSTRACT: BACKGROUND: Treatment of peripherally located liver tumors with diaphragmatic invasion is technically demanding but does not preclude resection for cure. The aim of the present study was to compare patients undergoing combined liver and diaphragmatic resection with those submitted to hepatectomy alone so as to evaluate the safety, effectiveness, and value of this complex surgical procedure. METHODS: From January 2000 to September 2011, 36 consecutive patients underwent en bloc liver-diaphragm resection (group A). These were individually matched for age, gender, tumor size, pathology, and co-morbitidies with 36 patients who underwent hepatectomy alone during the same time (group B). Operative time, warm ischemia time, blood loss, required transfusions, postoperative complications, and long-term survival were evaluated. RESULTS: Mean operative time was significantly longer in group A than in group B (165 vs 142 min; P = 0.004). The two groups were comparable regarding warm ischemia time, intraoperative blood loss, required transfusions, and postoperative laboratory value fluctuations. Some 33 % of group A patients developed complications postoperatively as opposed to 23 % of group B patients (P = 0.03). The mortality rate was 2.8 % in group A compared to 0 % in group B. Postoperative follow-up demonstrated 60 % 1-year survival for group A patients as opposed to 80 % 1-year survival for group B patients, a difference that is practically eliminated the longer the follow-up period is extended (35 vs 40 % 3-year survival and 33 vs 37 % 5-year survival for group A and group B patients, respectively). CONCLUSIONS: En bloc diaphragmatic and liver resection is a challenging but safe surgical procedure that is fully justified when diaphragmatic infiltration cannot be ruled out and the patient is considered fit enough to undergo surgery.
  World Journal of Surgery 05/2013; · 2.36 Impact Factor
• Article: Central hepatectomy under sequential hemihepatic control.

  Nikolaos Arkadopoulos, Maria A Kyriazi, Kassiani Theodoraki, Pantelis Vassiliou, Apostolos Perelas, Ioannis Vassiliou, Vassilios Smyrniotis
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  ABSTRACT: PURPOSE: Central hepatectomy is a complex, parenchymal-sparing procedure which has been associated with increased blood loss, prolonged operating time, and increased duration of remnant hypoxia. In this report, we compare two different techniques of vascular control, namely sequential hemihepatic vascular control (SHHVC) and selective hepatic vascular exclusion (SHVE) in central hepatectomies. METHODS: From January 2000 to September 2011, 36 consecutive patients underwent a central hepatectomy. SVHE was applied in 16 consecutive patients, and SHHVC was applied in 20 patients. Both groups were comparable regarding their demographics. RESULTS: Total operative time and morbidity rates were similar in both groups. Warm ischemia time was significantly longer in SVHE patients (46 min vs 28 min, p = 0.03). Total blood loss and number of transfusions per patient were also higher in the SVHE group (650 vs. 400 mL, p = 0.04 and 2.2 vs. 1.2 units, p = 0.04, respectively). AST values were significantly higher in SVHE on days 1 and 3 compared to SHHVC patients (650 vs. 400, p = 0.04 and 550 vs. 250, p = 0.001, respectively). CONCLUSION: Sequential hemihepatic vascular control is a safe technique for central hepatectomies. Decreased intraoperative blood loss and transfusions and attenuated liver injury are the main advantages of this approach.
  Langenbeck s Archives of Surgery 08/2012; · 1.81 Impact Factor
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  Available from: Maria A Kyriazi

  Article: On the management of hyperglycaemia in critically ill patients undergoing surgery.

  Iakovos Nomikos, Maria Kyriazi, Dimitra Vamvakopoulou, Andreas Sidiropoulos, Athanasios Apostolou, Aspasia Kyritsaka, Evangelos Athanassiou, Nikolaos C Vamvakopoulos
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  ABSTRACT: Hyperglycaemia is a major health risk and a negative determinant of surgical outcome. Despite its increasing prevalence, the limited treatments for restoration of normoglycaemia make its effective management a highly complex individualized clinical art. In this context, we review the mechanisms leading to hyperglycaemic damage as the basis for effective management of surgical complications of diabetic and non diabetic critically ill patients.
  Journal of Clinical Medicine Research 08/2012; 4(4):237-41.
• Article: Extrahepatic portal vein ligation in major hepatectomies performed under selective vascular exclusion: a case-control study.

  Nikolaos Arkadopoulos, Maria A Kyriazi, Kassiani Theodoraki, George Sakorafas, Aliki Tympa, John Skalkidis, Ioannis Vassiliou, Vassilios Smyrniotis
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  ABSTRACT: The aim of our study is to assess the effect of extrahepatic ipsilateral portal vein branch ligation in hepatectomies conducted under selective hepatic vascular exclusion with sharp transection of the liver parenchyma. Twenty-six patients (Group A) underwent major hepatectomy from January 2007 to December 2009, and hemostasis was achieved by ligation of the ipsilateral portal vein branch in addition to suture ligation of the cut surface vessels. A control group (Group B) was composed of 26 matched patients picked from our hospital's database, in which hemostasis was achieved by suture ligation of the cut surface vessels only. Warm ischemia time, intraoperative blood loss, blood transfusions, and liver function were compared. Reduced blood loss (450 vs 680 mL, P = 0.03), less transfusions (8 vs 20% of the patients, P = 0.04), and decreased warm ischemia time (34 vs 42 minutes, P = 0.04) were observed in Group A. Extrahepatic ligation of the ipsilateral portal vein branch is simple, safe, and effective in reducing blood loss and warm ischemia time in major hepatectomies performed under selective vascular exclusion.
  The American surgeon 03/2012; 78(3):300-4. · 1.28 Impact Factor
• Article: Evaluation of ischemia-reperfusion liver injury by near-infrared spectroscopy in an experimental swine model: the effect of desferoxamine.

  Maria A Kyriazi, Kassiani Theodoraki, Theodosios Thedosopoulos, Paraskevi Tsiantoula, George Fragulidis, Georgia Kostopanagiotou, Vassilios Smyrniotis, Nikolaos Arkadopoulos
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  ABSTRACT: Ischemia-reperfusion (I-R) injury has long been regarded a primary factor for the physiological dysfunction that can occur following major liver resection performed under vascular control. The aim of our study was to assess the effect of treatment with desferoxamine (DFO), a potent antioxidative agent, monitoring the I-R injury on a porcine model of major hepatectomy. Twelve female pigs were allocated to control (n = 6) and DFO groups (n = 6) and underwent 30 min of liver ischemia, during which a ≥30% hepatectomy was performed, followed by six hours of postoperative monitoring. The DFO group animals were preconditioned with a continuous iv solution of DFO to a total dose of 100 mg/kg during their postoperative period. Liver remnants (≈70% of initial liver volume) were evaluated by means of infrared spectroscopy, serum lactate measurement of the systemic, portal and hepatic vein blood, and by immunohistochemical assessment of apoptosis in consecutive liver biopsies. DFO group demonstrated considerably faster restoration of tissue oxygenation (92.33% vs. 80%, p < .05) and serum lactate values (1.23 mmol/l vs. 2.27 mmol/l, p < .05). Moreover, apoptosis as estimated by TUNEL and caspase-3 staining was significantly lower in the DFO group (0.06% vs. 1.17% and 1.17% vs. 2%, respectively, p < .05). The severity of the I-R injury showed a linear correlation to the restoration of tissue oxygenation, as estimated by infrared-spectroscopy (r(2) = 0.81, p < .01). Iron chelation with DFO appears to attenuate I-R injury of the liver remnant following hepatectomy, as reflected by faster restoration of tissue oxygenation and lower apoptotic activity.
  Journal of Investigative Surgery 01/2011; 24(4):164-70. · 1.09 Impact Factor