Georgios C Sotiropoulos

University Hospital Essen, Essen, North Rhine-Westphalia, Germany

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Publications (251)699.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Perioperative liver graft injury is associated with elevation of aminotransferases after orthotopic liver transplantation (OLT). Values above 5000U/l usually are regarded as extreme liver graft injury (ELGI). Some patients and organs recover from this critical condition. The aim of the study was to evaluate factors contributing to graft and patient survival after ELGI.From chart review we identified 64 out of 917 OLT adult patients (median age 54.2 years; 68.8% males) transplanted between 11/2003 and 02/2012, who presented ELGI after OLT. Donor and recipient factors were analyzed and correlated with the outcome by univariable and multivariable methods.Multivariable cox proportional hazards showed that recipient's BMI (p=0.01), MELD score before OLT (p=0.02) and laboratory MELD score 24 hours after OLT (p=0.01) were independently associated with patient survival. 30-days and 12-months survival in patients with a postoperative laboratory MELD higher than 31 was 21.4%, while patients with a postoperative laboratory MELD lower than 31 displayed 30-days and 12-months survival rates of 80% and 71.8%, respectively (p<0.001).Retransplantation in the setting of ELGI after OLT should be based on all available data. Utilization of the postoperative labMELD enables the transplant physician within 24 hours after transplantation to identify necessity of retransplantation objectively.This article is protected by copyright. All rights reserved.
    Transplant International 07/2014; · 3.16 Impact Factor
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    ABSTRACT: The association between tumor size and survival in patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection is controversial. We sought to define the incidence of major and microscopic vascular invasion relative to ICC tumor size, and identify predictors of microscopic vascular invasion in patients with ICC ≥5 cm. A total of 443 patients undergoing surgical resection for ICC between 1973 and 2011 at one of 11 participating institutions were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. As tumor sized increased, the incidence of microscopic vascular invasion increased: <3 cm, 3.6 %; 3-5 cm, 24.7 %; 5-7 cm, 38.3 %; 7-15 cm, 32.9 %, ≥15 cm, 55.6 %; (p < 0.001). Increasing tumor size was also found to be associated with worsening tumor grade. The incidence of poorly differentiated tumors increased with increasing ICC tumor size: <3 cm, 9.7 %; 3-5 cm, 19.8 %; 5-7 cm, 24.2 %; 7-15 cm, 21.1 %; >15 cm, 31.6 % (p = 0.04). The presence of perineural invasion (odds ratio [OR] = 2.98) and regional lymph node metastasis (OR = 4.43) were independently associated with an increased risk of microscopic vascular invasion in tumors ≥5 cm (both p < 0.05). Risk of microscopic vascular invasion and worse tumor grade increased with tumor size. Large tumors likely harbor worse pathologic features; this information should be considered when determining therapy and prognosis of patients with large ICC.
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 05/2014;
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    Demetrios Moris, Georgios C Sotiropoulos, Spiridon Vernadakis
    Annals of surgery. 05/2014;
  • 40ο Πανελλήνιο Ιατρικό Συνέδριο, Athens Hilton; 05/2014
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    Spiridon Vernadakis, Demetrios Moris, Georgios C Sotiropoulos
    Transplantation 03/2014; 97(6):e35-6. · 3.78 Impact Factor
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    ABSTRACT: IMPORTANCE Intrahepatic cholangiocarcinoma (ICC) is a primary cancer of the liver that is increasing in incidence, and the prognostic factors associated with outcome after surgery remain poorly defined. OBJECTIVE To combine clinicopathologic variables associated with overall survival after resection of ICC into a prediction nomogram. DESIGN, SETTING, AND PARTICIPANTS We performed an international multicenter study of 514 patients who underwent resection for ICC at 13 major hepatobiliary centers in the United States, Europe, and Asia from May 1, 1990, through December 31, 2011. Multivariate Cox proportional hazards regression modeling with backward selection using the Akaike information criteria was used to select variables for construction of the nomogram. Discrimination and calibration were performed using Kaplan-Meier curves and calibration plots. INTERVENTIONS Surgical resection of ICC at a participating hospital. MAIN OUTCOMES AND MEASURES Long-term survival, effect of potential prognostic factors, and performance of proposed nomogram. RESULTS Median patient age was 59.2 years, and 53.1% of the patients were male. Most patients (74.7%) had a solitary tumor, and median tumor size was 6.0 cm. Patients were treated with an extended hepatectomy (202 [39.3%]), a hemihepatectomy (180 [35.0%]), or a minor liver resection (<3 segments) (132 [25.7%]). Most patients underwent R0 resection (87.9%), and 35.7% of patients had N1 disease. Using the backward selection of clinically relevant variables, we found that age at diagnosis (hazard ratio [HR], 1.31; P < .001), tumor size (HR, 1.50; P < .001), multiple tumors (HR, 1.58; P < .001), cirrhosis (HR, 1.51; P = .08), lymph node metastasis (HR, 1.78; P = .01), and macrovascular invasion (HR, 2.10; P < .001) were selected as factors predictive of survival. On the basis of these factors, a nomogram was created to predict survival of ICC after resection. Discrimination using Kaplan-Meier curves, calibration curves, and bootstrap cross-validation revealed good predictive abilities (C index, 0.692). CONCLUSIONS AND RELEVANCE On the basis of an Eastern and Western experience, a nomogram was developed to predict overall survival after resection for ICC. Validation revealed good discrimination and calibration, suggesting clinical utility to improve individualized predictions of survival for patients undergoing resection of ICC.
    JAMA surgery. 03/2014;
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    ABSTRACT: Introduction Detailed knowledge of the biliary anatomy is essential to avoid complications in Living Donor Liver Transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and Methods 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w+/-IR) were acquired 20-30 minutes after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann-Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC + IR.
    European journal of radiology 01/2014; · 2.65 Impact Factor
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    ABSTRACT: Poor initial graft function was recently newly defined as early allograft dysfunction (EAD) (Olthoff et al. 2010). Aim of this analysis was to evaluate predictive donor information for development of EAD. 678 consecutive adult patients (mean age 51.6 years; 60.3% males) who received a primary LT (09/2003 - 12/2011) were included. Standard donor data was correlated with EAD and outcome by univariable/multivariable logistic regression and cox proportional hazards to identify prognostic donor factors after adjustment for recipient confounders. Estimates of relevant factors were utilized for construction of a new continuous risk index to develop EAD. 38.7% patients developed EAD. 30-day-survival of grafts with and without EAD was 59.8% and 89.7% (p< 0.0001). 30-day-survival of patients with and without EAD was 68.5% and 93.1% (p<0.0001), respectively. Donor BMI (p=0.0112), gGT (p=0.0471), macrosteatosis (p=0.0006) and cold ischemia time (CIT) (p=0.0031) were predictors of EAD. Internal cross validation showed a high predictive value (c-index=0.622). EAD correlates with early results of LT and can be predicted by donor data only. The newly introduced risk index potentially optimizes individual decisions to accept/decline high risk organs. Outcome of these organs might be improved by shortening CIT. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 12/2013; · 3.87 Impact Factor
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    ABSTRACT: Steatosis in donor livers is an accepted adverse prognostic factor after liver transplantation. While its semiquantitative assessment shows varying reproducibility, it is questioned as a standard method. Additionally, the influence of hepatic steatosis on ischemia/reperfusion injury (I/R injury) has not been evaluated in biopsies after reperfusion. We compared different staining and analyzing methods for the assessment of donor liver steatosis in order to predict I/R injury and clinical outcome after transplantation. To do this, 56 paired pre- and post-reperfusion liver biopsies were analyzed for macro- (MaS)/micro- (MiS) and total steatosis in cryo and permanent sections by special fat (Oil Red O or ORO) and standard stains. Computerized morphometrical analyses were compared to the semiquantitative assessment by a pathologist. I/R injury was determined histopathologically and by M30 immunohistochemistry. We found ORO to be more sensitive in detecting hepatic steatosis with higher reproducibility for MaS. Semiquantitative analyses were highly reproducible and not inferior to computerized morphometry. Categorized MaS as determined by ORO correlated with the extent of I/R injury, initial poor function, liver enzymes, and survival. Therefore fat stains like ORO are a reliable and easy method comprising significant advantages in the evaluation of hepatic steatosis and are thereby of prognostic value. Computerized analysis is a precise tool though not superior to semiquantitative analyses.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 12/2013; · 2.68 Impact Factor
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    Andreas Paul, Georgios Sotiropoulos, Guido Gerken, Fuat Hakan Saner
    Journal of Hepatology 11/2013; · 9.86 Impact Factor
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    ABSTRACT: Liver resection for primary hepatic neuroendocrine carcinoma (phNEC) has only scarcely been reported in the literature. We herein report on a 19-year-old female with a solitary 27 × 13-cm-big phNEC, which was initially considered as hemangioma. An extended right hepatectomy (segments V-VIII, partially IVa) was performed. Resection margins were free of tumor (R0 resection). Ki67 expression was 35 %. Postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Two years after surgery, the patient remains disease-free and in good general condition. Large series and longer follow-up studies are required for the better understanding on this rare tumor entity.
    Journal of Gastrointestinal Surgery 10/2013; · 2.36 Impact Factor
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    ABSTRACT: Merkel cell carcinoma (MCC) is a rare potentially fatal skin tumor affecting older and immunosuppressed individuals. It is highly malignant with high rates of metastasis and poor survival.We present a case of a 67-year-old woman with a palpable mass in the upper abdomen. An abdominal CT revealed a mass in the tail of the pancreas. Two weeks before, lumpectomy of a 3.5 cm tumor of the left breast had been performed. Histology showed a primary neuroendocrine carcinoma of the mammary gland. The patient's medical history was significant for a 0.7 x 0.9 cm MCC removed from her left forearm 2.5 years ago. There was no evidence of vascular involvement or peritoneal disease and by all criteria was resectable. A somatostatin receptor scintigraphy showed an enhanced uptake in the pancreatic tail region. The tumor was immunohistochemically strong staining for synaptophysin and CD56. The diagnosis of a metastatic-MCC in the tail of the pancreas was made. Further histological investigation of the prior removed neuroendocrine breast tumor and the MCC of the left forearm confirmed neuroendocrine origin and identical histology to the previously resected MCC of the left forearm. In this article, we aim to highlight that MCC has the potential to spread even in unusual organs, such as pancreas or breast, and therefore a diligent follow-up should be applied in patients with MCC.
    World Journal of Surgical Oncology 10/2013; 11(1):261. · 1.09 Impact Factor
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    115ème Congrès Français de Chirurgie, Porte Maillot, Palais des Congrès de Paris; 10/2013
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    ABSTRACT: Minimal invasive techniques have allowed for major surgical advances. We report our initial experience of performing total laparoscopic left hepatectomy (segments II-IV) with the Lotus (laparoscopic operation by torsional ultrasound) Ultrasonic Scalpel. The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery. To the best of our knowledge, this is the first total laparoscopic hemihepatectomy to be performed in Greece, as well as the first laparoscopic liver resection using Lotus shears.
    World Journal of Gastroenterology 09/2013; 19(35):5929-5932. · 2.55 Impact Factor
  • International Journal of Colorectal Disease 09/2013; · 2.24 Impact Factor
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    ABSTRACT: Εισαγωγή: Η γεωγραφική κατανομή της χώρας μας και το αυξανόμενο ποσοστό ανασφάλιστων ασθενών επιβάλλει την εξεύρεση αποτελεσματικών και αποδοτικών λύσεων σε περιπτώσεις ηπατικής κακοήθειας με παρηγορητική θεώρηση, καθώς οι επαναλαμβανόμενες ενδοσκοπικές παρεμβάσεις και τα αναγκαία υλικά δεν είναι προσβάσιμα για όλο τον πληθυσμό. Σε αυτή τη βάση η διενέργεια παρηγορητικής ηπατονηστιδοστομίας που περιγράφηκε πριν από μία 10ετία μπορεί να αναβιώσει στην Ελληνική πραγματικότητα. Περιγραφή περιστατικών: Ανασφάλιστος και άνεργος ασθενής 54 ετών εισάγεται στη Γενική Εφημερία του Νοσοκομείου μας με αποφρακτικό ίκτερο. Από τον εργαστηριακό και απεικονιστικό έλεγχο (αξονική κοιλίας) διαπιστώνεται η ύπαρξη πυλαίου χολλαγγειοκαρκινώματος, χωρίς ενδοηπατικές μεταστάσεις. Ο περαιτέρω απεικονιστικός έλεγχος με Μαγνητική Τομογραφία-MRCP και η ενδοσκοπική ή ακτινολογική αντιμετώπιση του ικτέρου (τιμή ολικής χολερυθρίνης 12,89mg/dl) καθίστανται ανέφικτες λόγω αδυναμίας οικονομικής κάλυψης των αναγκών. Ο ασθενής υποβάλλεται σε ερευνητική λαπαροτομία, χολοκυστεκτομή και εκτομή των εξωηπατικών χοληφόρων, αποστολή ταχείας βιοψίας, η οποία αναδεικνύει διηθημένα όρια (R1) στο ενδοπαγκρεατικό τμήμα του χοληδόχου πόρου, στον δεξιό και αριστερό ηπατικό πόρο. Διενεργείται διπλή ηπατικονηστιδοστομία κατά Roux-en-Y στον δεξιό και αριστερό ηπατικό πόρο, ενώ επιπλέον περιφερική εκτομή από τα τμήματα 2 και 3 του ήπατος και bypass Roux-en-Y ηπατονηστιδική αναστόμωση στο ηπατικό παρέγχυμα των άνω τμημάτων. Ο ασθενής αναρρώνει ταχέως, οι χολοστατικοί παράγοντες υποχωρούν στις φυσιολογικές τιμές. O ασθενής εξέρχεται την 14η μετεγχειρητική ημέρα. Ο ασθενής παραμένει σε πολύ καλή γενική κατάσταση, με εργαστηριακές εξετάσεις στα φυσιολογικά επίπεδα, χωρίς εκ νέου εισαγωγή στο Νοσοκομείο 10 μήνες μετά το Χειρουργείο. Ασθενής 78 ετών από τη Λέρο παρακολουθείται επί 5ετία σε Νοσοκομεία των Δωδεκανήσων για ένα μόρφωμα δεξιού λοβού ήπατος με απεικονιστικά χαρακτηριστικά σηραγγώδους αιμαγγειώματος. Λόγω εμφάνισης αποφρακτικού ικτέρου ικτέρου (τιμή ολικής χολερυθρίνης 9,65mg/dl) σε επανάληψη του απεικονιστικού ελέγχου διαπιστώνεται ραγδαία αύξηση του μεγέθους του ηπατικού μορφώματος στα 12cm η ασθενής εισάγεται στην κλινική μας και υποβάλλεται σε ερευνητική λαπαροτομία. Διαπιστώνεται ύπαρξη μέτριας ποσότητας ασκιτικού υγρού, στεατωτικό-ινωτικό ήπαρ και διήθηση του δεξιού κλάδου της πυλαίας από το μόρφωμα του δεξιού λοβού. Η ταχεία βιοψία αναδεικνύει ενδοηπατικό χολλαγγειοκαρκίνωμα. Διενεργείται bypass Roux-en-Y ηπατονηστιδική αναστόμωση στο ηπατικό παρέγχυμα των τμημάτων 2 και 3. Η ασθενής εξέρχεται την 13η μετεγχειρητική ημέρα. Η ασθενής παραμένει σε καλή γενική κατάσταση, με εργαστηριακές εξετάσεις στα φυσιολογικά επίπεδα, χωρίς εκ νέου εισαγωγή στο Νοσοκομείο 5 μήνες μετά το Χειρουργείο. Συμπέρασμα: Η διενέργεια παρηγορητικής ηπατονηστιδοστομίας μπορεί είναι αποτελεσματική και μπορεί να δώσει αποδοτικές λύσεις στην Ελληνική πραγματικότητα.
    13ο Πανελλήνio Ηπατολογικό Συνέδριο, Ρόδος, Sheraton Rhodes Resort; 05/2013
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    Demetrios Moris, Georgios Sotiropoulos, Spiridon Vernadakis
    The American surgeon 05/2013; 79(5):194-6. · 0.92 Impact Factor
  • Georgios C Sotiropoulos, Gregory Kouraklis
    Annals of surgery 04/2013; · 7.90 Impact Factor
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    ABSTRACT: INTRODUCTION: Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC. METHODS: We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS: During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P < .001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P = .04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P = .04), and tumor size ≥5 cm (HR, 1.84; 95% CI, 1.28-2.65; P < .001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively. CONCLUSION: Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence.
    Surgery 03/2013; · 3.37 Impact Factor

Publication Stats

2k Citations
699.34 Total Impact Points

Institutions

  • 2003–2014
    • University Hospital Essen
      • • Institute of Diagnostic and Interventional Radiology and Neuroradiology
      • • Surgical Clinic (Outpatient and Inpatient)
      • • Institute of Pathology and Neuropathology
      Essen, North Rhine-Westphalia, Germany
  • 2013
    • University of Maryland, Baltimore
      • Department of Surgery
      Baltimore, MD, United States
    • Laiko Hospital
      Athínai, Attica, Greece
  • 2011–2013
    • Johns Hopkins University
      • Department of Surgery
      Baltimore, MD, United States
  • 2006–2013
    • University of Duisburg-Essen
      • Faculty of Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2012
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2010
    • Institut za onkologiju i radiologiju Srbije
      Beograd, Central Serbia, Serbia
  • 2009
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2008–2009
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
    • Aristotle University of Thessaloniki
      Saloníki, Central Macedonia, Greece
    • University of Wuerzburg
      Würzburg, Bavaria, Germany