Publications (14)32.51 Total impact
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Article: Bronchial washing levels of vascular endothelial growth factor receptor-2 (VEGFR2) correlate with overall survival in NSCLC patients.
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ABSTRACT: The aim of this study was to define pre-treatment VEGF, VEGFR1 and VEGFR2 levels in serum and bronchial washing samples of NSCLC patients in order to examine their correlation to survival. Forty patients with histologically confirmed NSCLC were enrolled. The results indicated that circulating VEGF was correlated to T-classification, as were the ratios of VEGF/VEGFR2 in serum and washing. Best chemotherapy response was observed at lower serum and washing VEGF concentrations. Higher VEGF levels in washing were associated with worse overall survival and progression-free survival. Similar were the results at high values of VEGF/VEGFR2 ratio in washing. Multivariate analysis revealed VEGFR2 levels in serum and washing as independent markers for overall survival. In conclusion, washing VEGFR2 levels are correlated to overall survival, whereas serum and washing VEGF levels are predictive of chemotherapy response. These could help recognize NSCLC patients who benefit from an aggressive therapeutic approach.Cancer letters 03/2011; 304(2):144-53. · 4.86 Impact Factor -
Article: Carboplatin-pemetrexed adjuvant chemotherapy in resected non-small cell lung cancer (NSCLC): a phase II study.
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ABSTRACT: The aim of this study was to determine the progression-free survival (PFS) and toxicity associated with adjuvant administration of carboplatin and pemetrexed for completely resected patients with stage IB, II and IIIA non-small cell lung cancer (NSCLC). Forty-five eligible NSCLC patients received surgical resection for pathological stage IB, II or IIIA followed by postoperative adjuvant chemotherapy with carboplatin AUC5 and pemetrexed administered on days 1 and 14 on a 28-day cycle. Recombinant human granulocyte colony-stimulating factor (rhG-CF) was given prophylactically. The mean time to disease progression of patients was 26 months. Toxicities were generally mild to moderate and entirely manageable. The administration of carboplatin and pemetrexed is a safe, well-tolerated and convenient regimen in the adjuvant setting of completely resected NSCLC, with efficacy similar to that reported in other regimens but less toxicity.Anticancer research 10/2009; 29(10):4297-301. · 1.73 Impact Factor -
Article: Sleeve lobectomy for patients with non-small-cell lung cancer: a simplified approach.
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ABSTRACT: Pulmonary parenchyma-saving procedures, indicated for central tumours, seem to have better results than pneumonectomy, an alternative procedure. The purpose of this study is to report our experience at our institution with sleeve lobectomy with regard to surgical technique and outcome. We retrospectively reviewed the records of 45 patients who underwent sleeve lobectomy for non-small-cell lung cancer, with a curative intent, during the period of January 2004 and January 2008. Four of these patients underwent bronchovascular reconstructive procedures. A minor modification of the running suture technique used for bronchoplasties is described here. The study identified 40 men and five women with a median age of 64 years (range: 24-80 years). All 45 patients underwent oncological resections with negative results for malignancy bronchial resection margins. Neither bronchial nor vascular complications occurred. Complications were observed in 15% of our patients and included prolonged air leak in three, atelectasis needing daily bronchoscopy in three and respiratory failure due to pneumonia in one patient, who eventually died, accounting for a mortality rate of 2%. The follow-up period ranged from 1 to 52 months, with a median of 26 months, and it was complete for 43 (96%) of the patients. The overall 4-year survival was 57%. Sleeve lobectomy for lung cancer, although technically demanding, is associated with low morbidity and mortality and satisfactory immediate and long-term results. With increasing experience, more lung-sparing procedures should be performed in selected patients.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2009; 36(6):1045-9. · 2.40 Impact Factor -
Article: Postoperative residual pleural spaces: characteristics and natural history.
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ABSTRACT: This study was conducted in order to re-define the incidence and natural history of postresectional residual pleural spaces (PRS). From 1997 to 2005, 966 patients who were subjected to less than entire lung resections, were followed and any cases of PRS were recorded. The records of these patients were retrospectively analyzed for age, gender, type of resection, side, apical or basal location, size, PRS wall thickness, empyema as well as for bronchopleural fistula occurence, management, and outcome. Postresectional residual pleural spaces outcome was correlated with space characteristics. A total of 92 cases (9.5%) of PRS were documented which developed frequently ( p < 0.001) after upper lobectomies, malignant disease, at an apical location, and on the right side. Unfavorable outcome was strongly correlated with age > 70 years ( p < 0.001), air leak ( p < 0.001), empyema ( p < 0.001), and thickened pleura ( p < 0.001). Good prognosis of PRS was strongly correlated with male gender, apical location, right side, normal pleura thickness, and small size. Postresectional residual pleural spaces of small size without any associated complications should not prolong hospitalization time.Asian cardiovascular & thoracic annals 02/2007; 15(1):54-8. -
Article: Images in cardiothoracic surgery. Localized fibrous mesothelioma: an extremely rare benign pleural tumor.
The Annals of thoracic surgery 07/2006; 81(6):2316. · 3.74 Impact Factor -
Article: Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study.
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ABSTRACT: A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion. From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia. Seventy patients were managed with sole tube thoracostomy (group A) and 57 with combination of tube thoracostomy and streptokinase instillation (group B). Groups were statistically compared for the age, gender, duration of symptoms, quality of pleural fluid, chest imaging, complete drainage, length of hospital stay and mortality. Multivariate analysis was used in order to define the factors that affect outcome. Tube thoracostomy was successful in 47 (67.1%) cases (group A), while fibrinolysis led to a favorable outcome in 50 cases (87.7%) (P<0.05). The length of stay in thoracic surgical department was significantly longer for group A (P<0.001). Mortality rate in group A was significantly higher (P<0.001). Multiple regression analysis disclosed as sole independent favorable factor for pleural drainage, the use of fibrinolysis during the course of chest tube drainage (P=0.006, odds ratio 4.29, 95% CI 1.51-12.14). Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.European Journal of Cardio-Thoracic Surgery 10/2005; 28(4):599-603. · 2.55 Impact Factor -
Article: Study on the late effect of pneumonectomy on right heart pressures using Doppler echocardiography.
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ABSTRACT: Changes in the pulmonary artery systolic pressure (PASP) and the dimensions of the right ventricle (RV) of the heart, six months after pneumonectomy, were evaluated in order to detect the influence of pneumonectomy on right heart function. 35 patients undergoing pneumonectomy (Group A) and 17 patients undergoing lobectomy or bilobectomy (Group B) were evaluated prospectively with spirometry, arterial blood gases determination and Doppler echocardiography at rest, preoperatively and six months postoperatively. Patients of both groups had normal preoperative PASP, RV dimensions and left ventricular ejection fraction. PASP was calculated using the equation: PASP=4x(maximal velocity of the tricuspid regurgitant jet)2+10 mmHg. FEV1, FVC, partial pressures of oxygen (pO2) and carbon dioxide in the arterial blood were considered as the main determinants of postoperative lung function. PASP increased significantly six months postoperatively in both groups (P<0.05). Mean PASP in Group A (40.51+/-12.52 mmHg) was significantly higher (P=0.012) than in Group B (32.88+/-5.25 mmHg). Mean PASP after right pneumonectomy (48.33+/-10.61 mmHg) was significantly higher (P=0.002) than after left pneumonectomy (35.26+/-10.83 mmHg). The incidence of RV dilatation was higher in Group A (60%) than in Group B (23.52%). RV dilatation was related with elevated PASP values in both groups (P<0.001 and P=0.034, respectively). Increased age (P<0.001), significant percent FVC reduction from preoperative values (P=0.012) and low pO2 values (P=0.001) were detected as strong predisposing factors for postpneumonectomy PASP elevation. Pneumonectomy is related with postoperative elevation of PASP and RV dilatation, especially right pneumonectomy. Significant percent FVC reduction, increased age and low pO2 values are the main responsible factors for elevation of the 6-month postoperative PASP values.European Journal of Cardio-Thoracic Surgery 09/2004; 26(3):508-14. · 2.55 Impact Factor -
Article: Involvement of lymphatic metastatic spread in non-small cell lung cancer accordingly to the primary cancer location.
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ABSTRACT: The purpose of the study is to investigate the contribution of lymphatic spread in operable non-small cell lung cancer (NSCLC) in relation to the cancer location. We retrospectively studied 557 consecutive patients [514 males and 43 females, mean age 62.5 +/- 9.1 years (range, 20-84)] who underwent a major lung resection due to NSCLC in our department, from January 1995 to December 1999. Preoperative staging for metastatic disease was negative. Extended mediastinal lymph node dissection was performed in all lung resections. The pathology report revealed 220 adenocarcinomas, 276 squamous-cell, 34 undifferentiated, 25 adenosquamous and 2 large-cell carcinomas. The TNM stage was IA in 52 patients, IB in 109, IIA in 20, IIB in 146, IIIA in 190, IIIB in 35 and IV in 5. The classification of disease was N0 in 240 (40.1%) patients, N1 in 179 (32.1%) and N2 in 138 (24.8%). Twenty-eight patients (5.03%) presented a skip metastasis to hilar lymph nodes, while 27 patients (4.85%) presented with skip metastasis to the mediastinum. The size of the primary tumors presenting with metastases was significantly smaller in adenocarcinomas compared to squamous-cell carcinomas (P = 0.046). Regarding the right lung, tumors originating in the upper lobe mainly metastasized to level No. 4, while tumors of the middle lobe spread to stations Nos. 4 and 7, and those in the lower lobe to level No. 7. Regarding the left lung, tumors originating in the upper lobe metastasized to level No. 5, while tumors within the lower lobe spread to stations, Nos. 7-9. Mediastinal lymph nodal dissection is necessary for the accurate determination of pTNM stage. It seems that there is no definite way for lymphatic spreading in relation to the location of the cancer. Skip metastasis to the mediastinal lymph nodes was present in 4.85% of our patients, while adenocarcinomas, even small-sized ones, are more aggressive than squamous-cell carcinomas.Lung Cancer 06/2004; 44(2):183-91. · 3.43 Impact Factor -
Article: Bilious pericardial effusion at initial presentation in a patient with lung cancer.
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ABSTRACT: BACKGROUND: Cardiac tamponade as the initial manifestation of metastatic cancer is a rare clinical entity. Furthermore, a thoraco-biliary fistula is another rare complication of echinococcosis due to rupture of hydatid cysts located at the upper surface of the liver to the pleural or pericardial cavity. We report a case of non-small cell lung cancer with a coexisting hepatic hydatid cyst presenting as a bilious pericardial effusion. CASE REPORT: A 66-year-old patient presented with cardiac tamponade of unknown origin. Chest CT-scan demonstrated a left central lung tumor, a smaller peripheral one, bilateral pleural effusions and a hydatid cyst on the dome of the liver in close contact to the diaphragm and pericardium. Pericardiotomy with drainage was performed, followed by bleomycin pleurodesis. The possible mechanism for the bilious pericardial effusion might be the presence of a pericardio-biliary fistula created by the hepatic hydatid cyst. CONCLUSIONS: This is the first case of a bilious pericardial effusion at initial presentation in a patient with lung cancer with coexisting hepatic hydatid cyst.World Journal of Surgical Oncology 12/2003; 1(1):24. · 1.12 Impact Factor -
Article: Chest wall hydatidosis as the unique location of the disease: Case report and review of the literature.
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ABSTRACT: The chest wall is a rare location of secondary hydatidosis, but secondary hydatidosis may occur from the rupture of a lung cyst, from a liver cyst invading the diaphragm into the pleural cavity, following previous thoracic surgery for hydatidosis, or by hematogenous spread. This report describes a case of chest wall hydatidosis, which was the primary disease site in the patient, who had no previous history or current disease (hydatidosis) at other sites. The cyst invaded and partially destroyed the 9th and 10th ribs and the 10th thoracic vertebra, and protruded outside the pleural cavity through the 9th intercostal space. Preoperative albendazole administration for 10 days, surgical resection of the disease through a posterolateral thoracotomy incision, and postoperative albendazole treatment resulted in a cure with no evidence of local recurrence or disease at other sites in four years of follow-up.The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses 06/2003; 14(3):167-9. · 0.76 Impact Factor -
Article: Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study on 259 pneumonectomies.
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ABSTRACT: To identify predisposing factors associated with cardiac rhythm disturbances during the early post-pneumonectomy period (first 7 postoperative days). During the study period (1995-1999), 259 pneumonectomies were performed for malignant (244 cases) or benign disease (15 cases). Postoperative monitoring of patients included continuous arterial pressure - rhythm monitoring and pulse oximetry. Cardiac rhythm disturbances during the intensive care unit stay were detected on the monitor screen and recorded with a 12-lead electrocardiogram. Cardiac rhythm disturbances associated with electrolytes or fluid balance abnormality, mediastinal deviation or surgical postoperative complications were excluded from the study. Age of patients, preexisting cardiac disease, side of pneumonectomy, intrapericardial procedures, stage of the malignant disease, expected postoperative FEV(1)<1200 ml, intraoperative transfusions of packed red cells, elevated right heart pressures, low postoperative serum magnesium levels and long operative times were considered as predisposing factors for the development of post-pneumonectomy cardiac rhythm disturbances. Statistical analysis has been made using logistic regression analysis, Student t-test and chi-square test. Cardiac rhythm disturbances were detected in 49 patients (18.91%). Atrial fibrillation/flutter (31 cases), supraventricular tachycardia (14 cases), and premature ventricular contractions (four cases) were the observed rhythm disturbances. Right pneumonectomy versus left pneumonectomy (P<0.0001) and intrapericardial pneumonectomy versus standard pneumonectomy (P<0.0001) were identified as strong predisposing factors for the establishment of post-pneumonectomy cardiac rhythm disturbances. Patients who established post-pneumonectomy cardiac rhythm disturbances had significantly higher (P=0.024) right ventricular systolic pressure (42.50+/-15.50 mmHg) when compared with patients who had postoperative sinus rhythm (29.07+/-7.71 mmHg) and had also longer operative times than patients who did not develop rhythm disturbances (P=0.015). Mortality rate in patients who developed post-pneumonectomy rhythm disturbances was 20.40%. Cardiac rhythm disturbances observed early after pneumonectomy are mainly of supraventricular origin, complicating right and intrapericardial pneumonectomies, patients with elevated right heart pressures and long operative times, and are associated with high mortality rates.European Journal of Cardio-Thoracic Surgery 03/2003; 23(3):384-9. · 2.55 Impact Factor -
Article: Is the reduction of forced expiratory lung volumes proportional to the lung parenchyma resection, 6 months after pneumonectomy?
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ABSTRACT: To preoperatively estimate the degree of first-second forced expired volume (FEV1) and forced vital capacity (FVC) reduction 6 months after pneumonectomy, according to the preoperative performed spirometry and bronchoscopy, and to estimate if the expected postoperative values of FEV1 and FVC are in accordance with the actual values. Thirty-five patients, who underwent pneumonectomy for non-small cell lung cancer between 1996 and 1999, were included in the perspective study. All patients had total or near total bronchial obstruction at preoperative bronchoscopy. Patients were divided into three groups according to the preoperative bronchoscopy findings: Group I, obstruction of the main bronchus (six patients); Group II, obstruction of a lobar bronchus (19 patients); and Group III, obstruction of a segmental bronchus (10 patients). The estimation of the percent reduction of FEV1 and FVC has been made according to the formula: percent reduction=(no. of bronchopulmonary segments to be resected-no. of obstructed segments) x 5.26%. The mean overall actual percent reduction of FEV1 and FVC differed significantly from the expected mean overall percent reduction of FEV1 and FVC (P=0.000 and P=0.001, respectively). The actual values were lower than the predicted values using the given formula. In group and subgroup analysis, the mean actual percent reduction of FEV1 and FVC differed significantly from the mean expected percent reduction of FEV1 and FVC in Groups I and II of patients (P<0.01), but no significant differences were observed in Group III of patients (P>0.05). No significant differences between expected and actual mean percent reduction of FEV1 and FVC was also observed in patients of Groups I and II, when lung or lobar atelectasis, respectively, was noted at preoperative chest X-ray (P>0.05). Only when a segmental bronchus was obstructed at the preoperative bronchoscopy or when lobar or lung atelectasis was the result of the main or lobar bronchus obstruction, the estimated, using the proposed formula, expected percent reduction of FEV1 and FVC values were close to the actual postoperative percent reduction of FEV1 and FVC.European Journal of Cardio-Thoracic Surgery 05/2002; 21(5):901-5. · 2.55 Impact Factor -
Article: Wedge resection of the bronchus: an alternative bronchoplastic technique for preservation of lung tissue
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ABSTRACT: Objectives: We present a modified wedge resection of the bronchus, as an alternative bronchoplastic technique for lung resection, in cases of patients with or without adequate pulmonary reserve to undergo a pneumonectomy, in order to preserve lung tissue. Methods: Seventeen patients underwent a major lung resection with wedge resection of the bronchus for non-small cell lung cancer (NSCLC) in our department, from March 1995 to October 1999. A right-sided NSCLC were diagnosed in 17 males, with a mean age 62.5±6.6 (range 51–72) years. Further workup was free of metastatic disease. All patients underwent a right posterolateral thoracotomy, under general anesthesia with a double lumen endotracheal tube. Twelve right upper lobectomies, four right upper and middle lobectomies and one carinal resection were performed. The wedge resection of the bronchus carried out longitudinally, along the bronchial tree, and the bronchial defect was reapproximated transversely, in a single-layer, with interrupted non-absorbable suture. The frozen section of the distal margin of the resected bronchus was negative for malignancy in all patients. Extended mediastinal lymph node dissection followed each lung resection. Results: The pathology report showed 12 squamous-cell carcinomas, three adenocarcinomas, one adenosquamous carcinoma and one neuroendocrine carcinoma. The differentiation of the carcinomas was well in two cases, moderate in ten and poor in five. The pTNM stage was IB in four patients (23.5%), IIA in one (5.9%), IIB in eight (47.1%) and IIIA in four (23.5%). The median disease-free distal margin of the bronchus was 5 mm (range 2–15 mm). The average postoperative hospital stay was 15 days (range 12–28 days). The morbidity and mortality rate was 11.8 and 5.9%, respectively. Postoperative follow-up was every 6 months. The average survival is 20.0±15.2 months (range 1–54 months). There are 12 patients alive, and their follow-up is negative for locoregional recurrence or distant metastasis. The survival study showed no significantly statistic relation to the histologic type, cancer differentiation, pTNM stage, and disease-free distal margin of resection larger or less than 0.5 cm (Kaplan–Meier study log rank method). Conclusions: The wedge resection of the bronchus as a bronchoplastic procedure is an easy, fast and safe technique of reparation of the bronchial tree. It presents not only a low rate of morbidity and mortality, but also a satisfactory survival.European Journal of Cardio-Thoracic Surgery 11/2001; · 2.55 Impact Factor -
Article: Biweekly administration of docetaxel and gemcitabine as adjuvant therapy for stage II and IIIA non-small cell lung cancer: a phase II study.
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ABSTRACT: The aim of this study was to determine the overall survival, progression-free survival, and toxicity associated with adjuvant administration of docetaxel and gemcitabine for completely resected patients with stage II and IIIA non-small cell lung cancer (NSCLC). Thirty-nine eligible patients had surgical resection for pathological stage II or IIIA disease and received postoperative gemcitabine 1000 mg/m2 followed by docetaxel 80 mg/m2 on days 1 and 14. Cycles were repeated every 28 days. Treatment compliance was acceptable, at 83%. The median duration of follow-up, time to disease progression, and overall survival was 36.7 months, 17 months and 21 months, respectively. Toxicities were acceptable. Treatment failure revealed brain metastasis (15%), intrathoracic recurrence (24%) and systemic metastasis (36%). The biweekly administration of docetaxel and gemcitabine is a safe, well-tolerated and convenient chemotherapy regimen in the adjuvant setting of completely resected NSCLC stage II and III, with efficacy similar to that reported in other regimens. Hence, this nonplatinum based regimen appears promising and warrants further evaluation.Anticancer research 27(4C):2887-92. · 1.73 Impact Factor
Top co-authors
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2007
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Νοσοκομείο Σωτηρία
Athens, Attiki, Greece
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2003–2006
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401 GSNA
Athens, Attiki, Greece
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2001
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Γενικό Νοσοκομείο Ασκληπιείο Βούλας
Voúla, Attiki, Greece
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