Odysseas Zoras

University Hospital of Ioannina, Yannina, Epirus, Greece

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Publications (31)70.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Gastrectomy as a primary treatment for patients with metastatic gastric cancer (M1) is highly controversial. Herein, a review of the literature was undertaken with the aim of assessing evidence regarding associated morbidity and mortality, overall survival, palliation and quality of life. A systematic review of the literature from 1980 to 2013 was undertaken to identify relevant studies. Outcome data were pooled, and combined overall effect sizes were calculated using fixed or random effects models. The search identified 19 non-randomized studies reporting on 2,911 patients. Overall postoperative mortality and morbidity were 14% and 27% and were higher in Western than in Asian patients. In studies published during the past decade postoperative mortality was less than 5%. The weighted 1- and 2-year overall survival rates were 38% and 17%, and were twice as high in Asian versus Western patients. In the meta-analysis, the 1-year overall survival was significantly higher in patients undergoing gastrectomy versus conservative (odds ratio (OR)=4.9, 95% confidence interval (CI)=3.2 to 7.5, p<0.0001) or gastrectomy versus non-resectional treatment (OR=2.6, 95% CI=1.7 to 4.3, p<0.0001). Studies reporting on quality of life and palliation indicate a possible benefit of such palliative gastrectomy. A possible benefit of gastrectomy compared to non-resectional treatment for stage IV gastric cancer in terms of survival and palliation was evident but has to be cautiously interpreted due to potential sources of bias of retrospective non-randomized studies. Several questions regarding the optimal management of these patients remain unanswered and require a properly-designed randomized trial.
    Anticancer research 05/2014; 34(5):2079-85. · 1.87 Impact Factor
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    ABSTRACT: Progress in the treatment of cancer over the past decade has been slow. Targeting a mutated gene of an individual patient tumor, tumor-guided agents, and the first draft of the human genome sequence have created an overenthusiasm to achieve personalized medicine. However, we now know that this effort is misleading. Extreme interpatient and intratumor heterogeneity, scarce knowledge in how genome-wide mutational landscape and epigenetic changes affect transcriptional processes, gene expression, signaling transduction networks and cell regulation, and clinical assessment of temporary efficacy of targeted drugs explain the limitations of these currently available agents. Trastuzumab and a few other monoclonal antibodies or small-molecule tyrosine kinase inhibitors (TKIs) represent an exception to this rule. By blocking ligand-binding receptor in patients with human epidermal growth factor receptor 2 (HER2) amplification and overexpression, trastuzumab added to chemotherapy in HER2-positive patients has been proven to provide significant overall survival benefit in both metastatic and adjuvant settings. Lapatinib, a small-molecule dual inhibitor (TKI) of both HER2 and EGFR (epidermal growth factor receptor) pathways, has an antitumor activity translated into progression-free survival benefit in HER2-positive metastatic patients previously treated with a taxane, an anthracycline, and trastuzumab. Despite these advances, ~25% of patients with HER2-positive breast cancer experience recurrence in the adjuvant setting, while in the metastatic setting, median survival time is 25 months. In this review, we discuss the safety, efficacy, and limitations of the trastuzumab emtansine (T-DM1) conjugate in the treatment of HER2-positive metastatic breast cancer. We also highlight Phase III randomized trials, currently underway, using either the T-DM1 conjugate or various combinations of monoclonal antibodies and TKIs. Moreover, in contrast with all these agents developed on the basis of "central dogma" of simplified reductionist transcription and single gene-phenotype linear relationship, we summarize the emerging, amazing era of next-generation, transcriptional circuitry and intracellular signaling network-based drugs guided by the latest advances in genome science and dynamics of network biology.
    OncoTargets and Therapy 01/2014; 7:491-500. · 1.34 Impact Factor
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    Biomarkers in Medicine 10/2013; 7(5):675-8. · 3.22 Impact Factor
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    ABSTRACT: Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy (minimum follow-up, 18 months; range, 18-61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05). Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.
    Microsurgery 07/2013; · 1.62 Impact Factor
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    ABSTRACT: BACKGROUND: Frailty is a phenotype characterized by complex and challenging medical problems and higher susceptibility to adverse health outcomes. It can be derived at by a multidimensional process known as comprehensive geriatric assessment (CGA), which assesses the functional reserves of the elderly. In this study we report for the first time on a prospective evaluation of the association between CGA and postoperative complications after elective laparoscopic cholecystectomy for biliary disease. METHODS: Fifty-seven patients older than 65 years who were to undergo elective laparoscopic cholecystectomy for uncomplicated biliary disease were prospectively examined. Preoperative CGA was performed and the patients were categorized as fit or frail. The main outcome of the study was the rate of any postoperative complication within 30 days of surgery. RESULTS: There were 29 women (50.9 %) and the median (interquartile range) age of the cohort was 73 (8.8) years. Thirty-two patients (56.1 %) were categorized as frail and 25 (43.9 %) as fit. The overall incidence of postoperative complications was 23.7 %, most of which were grade I and II (18.8 %). Frail patients, according to the CGA assessment, experienced a significantly higher incidence of postoperative complications compared to their fit counterparts (84.6 vs. 15.4 %, p = 0.023). Frail patients experienced a significantly higher frequency of prolonged (more than 2 days) postoperative hospital stay compared with their fit counterparts (p = 0.023). CONCLUSIONS: Preoperative CGA may predict postoperative complications and prolonged postoperative hospital stay of elderly patients who undergo elective laparoscopic cholecystectomy. Larger-scale studies independently assessing this association are warranted.
    Surgical Endoscopy 10/2012; · 3.31 Impact Factor
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    ABSTRACT: Only 5% of all cases of intussusceptions occur in adults. Intussusception complicating colonoscopy is an extremely rare event. Herein, we present a case of a 58-year-old man who developed ileocolic intussusception after a colonoscopy during which an adenomatous polyp was discovered in the terminal ileum. Eight hours after colonoscopy, the patient developed diffuse abdominal pain associated with vomiting and bloody diarrhea. A contrast-enhanced abdominal computed tomography scan revealed features of mechanical intestinal obstruction and a round soft tissue mass inside the right colon, followed by the wall of the intussusceptum. Emergency laparotomy revealed extended ileocecal intussusception with the polyp incarcerated by the ileocecal valve. A typical right hemicolectomy was performed, and the patient had an uneventful recovery. Histologic examination of the surgical specimen revealed an inflammatory fibroid polyp. Ileocolic intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonoscopy.
    Surgical laparoscopy, endoscopy & percutaneous techniques 06/2012; 22(3):e161-3. · 0.88 Impact Factor
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    ABSTRACT: The exclusion of cancer in endemic goiter is often difficult mainly because of the high number of nodules and the as-yet unclear natural history of diagnosed cancer in endemic goiter patients. In a large number of consecutive patients who were to undergo total thyroidectomy for endemic multinodular goiter, we assessed indications for surgery and thyroid cancer outcome. All patients who were to undergo total thyroidectomy for diffuse multinodular goiter on histological examination between January 1990 and October 2008 were evaluated. Of the 1,161 patients included in the study, 252 were cases of thyroid cancer (21.7%). Sensitivity of thyroid ultrasound (US) and fine-needle aspiration cytology (FNAC) for cancer detection was 30.3 and 64.1%, respectively. Differentiated thyroid carcinoma accounted for most of the tumors (96%), with 54.8% of them being papillary microcarcinomas, while bilateral-multicentric cancer occurred in 20.3%. In multivariate analysis, younger age (p = 0.06), sonographic findings (p = 0.03), and presence of histological thyroiditis (p = 0.09) were independently associated with the occurrence of tumors with diameter greater than 2 cm. The percentage of transient and permanent postoperative complications were approximately 25 and below 2%, respectively. After a median follow-up time of 78.5 months, overall recurrence rate was 6.7% and disease-specific mortality was 1.2%. As US and FNAC did not consistently detect cancer in patients with diffuse multinodular goiter in our endemic area, evidence-based indications for surgery in this group of patients is needed, although radical surgery and favorable tumor histology offer favorable outcomes in commonly diagnosed thyroid cancer after total thyroidectomy for endemic multinodular goiter.
    World Journal of Surgery 03/2012; 36(6):1286-92. · 2.35 Impact Factor
  • The International journal of biological markers 12/2011; 26(4):276-7. · 1.36 Impact Factor
  • Charalambos Batsis, Odysseas Zoras
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    ABSTRACT: Axillary lymph node dissection (ALND) during breastconserving surgery (BCS) or mastectomy has been the standard practice for the surgical treatment of breast cancer. To reduce side effects of ALND, sentinel lymph node dissection (SLND) has been developed and standardized for early-stage breast cancer. Until recently, micrometastases or metastases in one or more sentinel nodes was considered as indication for ALND. However, recent, large-scale, randomized trials have showed no survival benefit or improved locoregional control of ALND compared with no ALND when micrometastatic or metastatic disease is detected in sentinel lymph nodes (SLN). 1,2 Therefore, ALND can be considered an overtreatment in selected patients. Under these new practice-changing results, new recommendations for multidisciplinary treatment of early breast cancer also require modification. To highlight potential consequences by omitting complete ALND (cALND) after the publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 Study, 2 Caudle and colleagues 3 evaluated and shaped the new landscape for the multidisciplinary treatment of selected patients with early breast cancer. Based on the eligibility criteria and results from ACOSOG Z0011 trial, 2 a multidisciplinary team at MD Anderson now counsels the majority of women with clinical T1/T2, N0 tumors with a positive SLN who are undergoing breast-conserving surgery with whole breast irradiation that they may omit cALND with no significant impact on their rate of local-regional recurrence or overall survival. 3 Although this general guidance may benefit most of these women, there are some concerns. The ACOSOG Z0011 trial closed early because of slow accrual with a total of 891 patients, instead of 1,900 initially planned to enroll. At a relatively short median follow-up of 6.3 years, ipsilateral axillary recurrences were noted in 0.5% (n = 2) of patients after ALND versus 0.9% (n = 4) in the SLNDonly arm and longer follow-up is needed to determine whether this difference will be increased. Two different trends are now seen in the United States: a reduction in ALND rate and a dramatic increase in bilateral mastectomy by simultaneous decrease in the rate of BCS for various reasons including family history with positive or even negative BRCA1/2 testing, young age and others. 3,4 The ACOSOG Z0011 trial raises important questions about the origin of metastatic cancer cells. This study suggests that the primary tumor is similar to those of metastatic cells at axilla lymph nodes regarding their sensitivity to multimodal treatment. 2 Perhaps systemic treatment and radiation are able to kill potential residual disease in axilla lymph nodes. However, a recent wholegenome sequencing study in a woman with breast cancer regarding distant metastasis suggests that a different small subpopulation of cells within the primary tumor acquires the capacity of metastasis at distant organs. Emerging biomedical research using modern powerful genome-wide mapping technological advances in both cancer whole-genome sequencing and understanding how genetic and epigenetic changes deregulate gene expression patterns in cancer, provide rational optimism for personalized management of cancer. 5‐12
    Annals of Surgical Oncology 07/2011; 18 Suppl 3:S281-2. · 3.94 Impact Factor
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    ABSTRACT: Sentinel lymph node biopsy (SLNB) has been a reliable technique to accurately predict the axilla node status in women with breast cancer with clinically negative lymph nodes. Based on predictive accuracy evidence from large-scale clinical trials, SLNB has become the current standard of care in breast cancer, preventing unnecessary axilla lymph node dissection and its related adverse events in patients who test negative with SLNB. Now a Phase III randomized trial provides evidence that avoiding axilla lymphadenectomy in patients with positive SLNB does not increase locoregional recurrence or mortality. In this article the benefits, risks and selection criteria to safely prevent axilla lymphadenectomy even by positive SLNB are discussed. Moreover, limitations of this practice-changing trial are described with emphasis on caution in patient selection.
    Women s Health 07/2011; 7(4):417-8.
  • Odysseas Zoras, Charalambos Batsis
    Annals of Surgical Oncology 06/2011; 18 Suppl 3:S246-7. · 3.94 Impact Factor
  • Expert Review of Anti-infective Therapy 06/2011; 11(6):813-6. · 3.06 Impact Factor
  • John Spiliotis, Odysseas Zoras
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    ABSTRACT: In this study, the mean preoperative CRC plasma EGF level (123 pg/ml) was significantly higher than that of the benign group (85 pg/ml; p = 0.015). In the CRC group, the EGF levels were significantly decreased on postoperative days 1 and 3. In the benign group, the EGF levels were significantly lower than the preoperative level on postoperative day 3. The authors concluded that plasma EGF levels are significantly higher in cancer patients treated with laparoscopically assisted surgery. They noted that larger studies with more late samples are needed to
    Surgical Endoscopy 03/2011; 25(8):2766-7; author reply 2768. · 3.31 Impact Factor
  • John Spiliotis, Odysseas Zoras
    World Journal of Surgery 02/2011; 35(2):468-9; author reply 470-1. · 2.35 Impact Factor
  • John Spiliotis, Odysseas Zoras
    Surgical Endoscopy 02/2011; 25(2):658-60. · 3.31 Impact Factor
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    ABSTRACT: Chondrosarcomas of the spine are rare and difficult to treat. In this paper a case of thoracic chondrosarcoma is presented. Chondrosarcomas of the spine are generally smaller, more difficult to excise and are followed by higher local recurrence compared with chondrosarcomas of the peripheral skeleton. The tumor is radio- and chemoresistant, making the surgical treatment of utmost importance. The most important prognostic factor for local control is wide or marginal tumor resection. Our patient was treated in two stages, with total excision of the tumor, using cryosurgery. Liquid nitrogen was used to freeze the damaged tissue at a cellular level and made the excision more efficient.
    Case Reports in Medicine 01/2011; 2011:243243.
  • John Spiliotis, Odysseas Zoras
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    ABSTRACT: Background The aim of this study was to analyze the effects of preoperative cetuximab (cetu) on nontumorous liver parenchyma and the clinical and biological outcomes after liver resection for colorectal liver metastases (CLM). Methods Between January 2005 and June 2009, 26 patients who received preoperative cetu were matched to a control group of 26 patients who did not receive cetu. They were matched on the basis of age, gender, body mass index, extent of hepatectomy, and type and number of cycles of neoadjuvant chemotherapy. Results Liver function tests, postoperative outcome, and histopathology of the resected liver were compared. There was no mortality. Postoperative morbidity and perioperative bleeding rates were similar in both groups. Serum aspartate aminotransferase and serum alanine aminotransferase were higher on postoperative day 5 in the control group (p = 0.02 and p = 0.04, respectively). In the cetu group, the postoperative peaks of γ-glutamyl transpeptidase and alkaline phosphatase were statistically higher than in the control group. Interestingly, pathological review of the nontumorous liver parenchyma revealed no significant difference between patients who received cetu and those treated without cetu with respect to prevalence of steatosis, steatohepatitis, sinusoidal obstructive syndrome, and fibrosis. Conclusions The addition of cetu to the neoadjuvant chemotherapy regimens does not appear to increase the morbidity rate after hepatectomy for CLM, and also in cases of major hepatectomy. The pathological examination did not show additional injury to the nontumorous liver parenchyma.
    World Journal of Surgery 12/2010; 35(5):1153-4. · 2.35 Impact Factor
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    ABSTRACT: Ten years after the first complete human genome sequencing, next-generation sequencing (NGS) technology has revolutionized genomics and biomedical research. Here we discuss potential emerging and future applications of NGS platforms and how cancer genome advances may change current surgical oncology practice. Publications in PubMed with partial or complete human and cancer genome sequencing over the last decade have been retrieved and analyzed. Recently launched international large-scale consortiums for systematic study of causal (driver) mutations underlying common complex diseases such as cancer and more recent opinion articles by leading scientists have been considered to predict the prospects of integration genomics data into surgical oncology. Two dozen complete human genome sequences, and three full-genome sequencing in three cancer patients have recently been published. These studies and other cancer genome systematic studies evaluating genomic rearrangements and copy-number changes consistently reveal that cancer initiation and metastasis are much more complex than we thought. This high complexity and widespread variability of cancer genes, mutations, and deregulated signaling pathways among patients with the same cancer type, tumor stage, and clinicopathologic features explains the limited effectiveness of currently used biologically targeted agents. Yet the impact of genomics explosion in surgical oncology is little. Nevertheless, "big" biology consortiums such as the International Cancer Genome Project and other systematic studies in the areas of genetics, genomics, and epigenetics are now providing in-depth understanding of cancer, and shape new more rational ways towards novel therapeutics for improving oncologic outcomes of millions of patients worldwide. At the beginning of the second post-genomic decade, an explosion in genomic technology has revolutionized biomedical sciences. The ability of latest DNA sequencing technology to identify, in an unprecedented level, causal mutations driving cancer initiation and metastasis raises significant expectations for improving oncologic outcomes. Which are the challenges and perspectives to translate this genomic revolution into a surgical oncology-changing era?
    Journal of Surgical Research 11/2010; 173(2):365-9. · 2.12 Impact Factor
  • Women s Health 11/2010; 6(6):769-72.
  • Odysseas Zoras, John Spiliotis
    Surgical Endoscopy 11/2010; 25(6):2052-3; author reply 2054. · 3.31 Impact Factor

Publication Stats

77 Citations
70.66 Total Impact Points


  • 2010–2013
    • University Hospital of Ioannina
      Yannina, Epirus, Greece
    • University of Ioannina
      • School of Medicine
      Ioánnina, Ipeiros, Greece
  • 2002–2013
    • University of Crete
      • Department of General Surgery
      Retimo, Crete, Greece
  • 2003–2012
    • University Hospital of Heraklion
      Irákleio, Attica, Greece
  • 2010–2011
    • Metaxa Cancer Hospital
      Le Pirée, Attica, Greece