Georgios Papanikolaou

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (6)19.68 Total impact

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    ABSTRACT: Background:To evaluate surgical outcome and survival benefit after quaternary cytoreduction (QC) in epithelial ovarian cancer (EOC) relapse.Methods:We systematically evaluated all consecutive patients undergoing QC in our institution over a 12-year period (October 2000-January 2012). All relevant surgical and clinical outcome parameters were systematically assessed.Results:Forty-nine EOC patients (median age: 57; range: 28-76) underwent QC; in a median of 16 months (range:2-142) after previous chemotherapy. The majority of the patients had an initial FIGO stage III (67.3%), peritoneal carcinomatosis (77.6%) and no ascites (67.3%). At QC, patients presented following tumour pattern: lower abdomen 85.7%; middle abdomen 79.6% and upper abdomen 42.9%. Median duration of surgery was 292 min (range: a total macroscopic tumour clearance could be achieved. Rates of major operative morbidity and 30-day mortality were 28.6% and 2%, respectively.Mean follow-up from QC was 18.41 months (95% confidence interval (CI):12.64-24.18) and mean overall survival (OS) 23.05 months (95% CI: 15.5-30.6). Mean OS for patients without vs any tumour residuals was 43 months (95% CI: 26.4-59.5) vs 13.4 months (95% CI: 7.42-19.4); P=0.001. Mean OS for patients who received postoperative chemotherapy (n=18; 36.7%) vs those who did not was 40.5 months (95% CI: 27.4-53.6) vs 12.03 months (95% CI: 5.9-18.18); P<0.001.Multivariate analysis indentified multifocal tumour dissemination to be of predictive significance for incomplete tumour resection, higher operative morbidity and lower survival, while systemic chemotherapy subsequent to QC had a protective significant impact on OS. No prognostic impact had ascites, platinum resistance, high grading and advanced age.Conclusion:Even in this highly advanced setting of the third EOC relapse, maximal therapeutic effort combining optimal surgery and chemotherapy appear to significantly prolong survival in a selected patients 'group'.
    British Journal of Cancer 01/2013; 108(1):32-8. DOI:10.1038/bjc.2012.544 · 4.82 Impact Factor
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    ABSTRACT: Background:To evaluate surgical outcome and survival benefit after quaternary cytoreduction (QC) in epithelial ovarian cancer (EOC) relapse.Methods:We systematically evaluated all consecutive patients undergoing QC in our institution over a 12-year period (October 2000-January 2012). All relevant surgical and clinical outcome parameters were systematically assessed.Results:Forty-nine EOC patients (median age: 57; range: 28-76) underwent QC; in a median of 16 months (range:2-142) after previous chemotherapy. The majority of the patients had an initial FIGO stage III (67.3%), peritoneal carcinomatosis (77.6%) and no ascites (67.3%). At QC, patients presented following tumour pattern: lower abdomen 85.7%; middle abdomen 79.6% and upper abdomen 42.9%. Median duration of surgery was 292 min (range: a total macroscopic tumour clearance could be achieved. Rates of major operative morbidity and 30-day mortality were 28.6% and 2%, respectively.Mean follow-up from QC was 18.41 months (95% confidence interval (CI):12.64-24.18) and mean overall survival (OS) 23.05 months (95% CI: 15.5-30.6). Mean OS for patients without vs any tumour residuals was 43 months (95% CI: 26.4-59.5) vs 13.4 months (95% CI: 7.42-19.4); P=0.001. Mean OS for patients who received postoperative chemotherapy (n=18; 36.7%) vs those who did not was 40.5 months (95% CI: 27.4-53.6) vs 12.03 months (95% CI: 5.9-18.18); P<0.001.Multivariate analysis indentified multifocal tumour dissemination to be of predictive significance for incomplete tumour resection, higher operative morbidity and lower survival, while systemic chemotherapy subsequent to QC had a protective significant impact on OS. No prognostic impact had ascites, platinum resistance, high grading and advanced age.Conclusion:Even in this highly advanced setting of the third EOC relapse, maximal therapeutic effort combining optimal surgery and chemotherapy appear to significantly prolong survival in a selected patients 'group'.
    British Journal of Cancer 01/2013; Br J Cancer. 2013 Jan 15;108(1):32-8. DOI:10.1038/bjc.2012.544. · 4.82 Impact Factor
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    ABSTRACT: A large number of prospective and retrospective studies have established the value of complete tumor resection with no postoperative residual disease following primary cytoreductive surgery in patients with epithelial ovarian cancer (EOC). Other studies that were primarily retrospective have also shown a benefit of complete tumor resection following secondary or even tertiary cytoreduction. The benefits of complete tumor resection after quaternary cytoreductive surgery are unknown. The aim of this study was to determine surgical outcome and overall survival (OS) after quaternary cytoreduction (QC) in patients with recurrent EOC. A systematic evaluation was performed of relevant and surgical outcome parameters including the tumor dissemination pattern at surgery, the procedures performed, and operative morbidity and mortality. The study population was composed of 49 women with EOC undergoing QC over a 12-year period (2000–2012) at an urban hospital in Germany. Participants (mean age, 57 years) had QC with a median of 16 months after previous chemotherapy. The majority of the patients (67.3%) had an initial FIGO stage III tumor; at surgery, 77.6% had peritoneal carcinomatosis, and 67.3% had no ascites. Patients at presentation had tumor involvement of the lower abdomen (85.7%), middle abdomen (79.6%), and upper abdomen (42.9%). Median duration of surgery was 292 minutes. A total macroscopic tumor clearance could be obtained in 32.6% of the patients. Major operative morbidity and 30-day mortality rates were 28.6% and 2%, respectively. Mean follow-up after QC was 18.41 months (95% confidence interval [CI], 12.64–24.18 months), and mean OS was 23.05 months (95% CI, 15.5–30.6 months). Patients who achieved total macroscopic tumor clearance had a mean OS of 43 months (95% CI, 26.4–59.5 months), whereas those with residual disease had mean OS rates of 13.4 months (95% CI, 7.42–19.4 months; P = 0.001). Mean OS was significantly higher among patients who received postoperative chemotherapy compared with patients who received no chemotherapy (40.5 months [95% CI, 27.4–53.6 months] vs 12.03 months [95% CI, 5.9–18.18 months]; P < 0.001). With multivariate analysis, multifocal tumor dissemination was shown to have predictive significance for incomplete tumor resection, higher operative morbidity, and lower OS; systemic chemotherapy subsequent to QC had a significant protective impact on OS. Other factors such as ascites, platinum resistance, high grading, and advanced age had no prognostic significance. These data indicate that a maximal therapeutic effort combining optimal tumor reduction and chemotherapy even in the setting of the third EOC relapse can significantly prolong survival in a highly selected population of patients.
    Obstetrical and Gynecological Survey 01/2013; 68(7):519-520. DOI:10.1097/01.ogx.0000432207.23416.c1 · 2.36 Impact Factor
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    ABSTRACT: Aim: Hepatic resection has become the standard treatment for patients with primary or metastatic liver malignancies. The aim of our study was to evaluate the clinical outcome of hepatic resection in patients with advanced ovarian cancer (AOC). All patients undergoing hepatic resection for AOC in our institution between 11/1991 and 02/2007 were evaluated by a validated intraoperative documentation tool. Seventy patients were evaluated (median age=59 years; range=29-76 years). Forty-one (58.6%) patients underwent liver resection; 29 patients had unresectable disease. Additional multivisceral procedures performed were: colic resection (51.4%), small bowel resection (32.9%), gastric resection (5.7%), pancreatic resection (4.3%), splenectomy (5.7%). The median survival of patients with R0 resection was 42 months (95% confidence interval (CI)=17-66 months), 4 months for R1, 6 months (95% CI=0-11 months) for R2, and 5 months (95% CI=0-9 months) for those without liver resection. In multivariate analysis, postoperative residual tumor mass was the strongest predictor of survival. Our data indicate that complete macroscopical tumor resection remains the strongest predictor of survival in patients with liver metastases from AOC.
    Anticancer research 10/2012; 32(10):4517-21. · 1.87 Impact Factor
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    ABSTRACT: The aim of this study was to assess operative feasibility and outcome after bevacizumab treatment (BT) in ovarian cancer (OC) patients. We retrospectively identified all OC patients operated between April 2006 and September 2010 after BT. We identified 733 OC operations, 10 of which (1.36%) were performed in a mean time of 134 days (range, 10-288) after BT. Indication was secondary cytoreduction in 3 patients (mean days after BT, 181; range, 82-256) and palliation in 7 due to bowel obstruction and/or intestinal perforation or fistula (mean days after BT, 114; range, 10-288). All but 1 acutely operated patients developed a secondary wound healing, but none of the 3 patients after planned cytoreduction did. Of these 3 patients, 1 suddenly died on the 36th postoperative day, presumably of thromboembolism. None of the patients developed postoperatively a gastrointestinal morbidity; however, in 1 patient operated 21 days after BT due to a vesicointestinal fistula the bladder reconstruction could not heal and developed a permanent fistula. Emergency surgery after BT due to bowel obstruction and/or fistulas seems to be associated with an impaired wound healing in advanced heavily pretreated platinum-resistant OC patients, while this does not appear the case in planned cytoreduction. Prospective evaluations are warranted to assess surgical safety after BT in this special patients' collective.
    Annals of Surgical Oncology 11/2011; 19(4):1326-33. DOI:10.1245/s10434-011-2134-0 · 3.94 Impact Factor
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    ABSTRACT: Intraperitoneal (i.p.) treatment with the trifunctional antibody catumaxomab is a novel promising option in the clinical management of advanced or recurrent epithelial ovarian cancer (EOC). As yet, no data exists sregarding the surgical experience after i.p. catumaxomab application. Therefore we analyzed the surgical outcome of EOC patients, previously treated with i.p. catumaxomab, with special focus on the effect on adhesion formation and morbidity. We conducted a retrospective evaluation of patients with EOC, who were previously treated with catumaxomab, either at time of primary cytoreduction (n=6) or due to malignant ascites in the recurrent situation (n=4), and who underwent surgery due to various indications between 01/2007 and 03/2010. Surgical outcome, grade of adhesions and operative morbidity were analyzed based on surgical reports and a validated intraoperative documentation tool 'Intraoperative Mappinf of Ovarian Cancer'. Ten patients with EOC (FIGO stage III-IV; median age 68 years; range: 45-77 years) were evaluated. The mean time between catumaxomab treatment and surgery was 187 days (range: 8-481 days). Mean operation-time was 185 minutes (range:69-32). The indications for surgery were as follows: 3 patients due to anastomotic insufficiency after primary tumor debulking; 2 patients due to secondary tumor debulking; 4 patients due to ileus in recurrent EOC; and 2 patients for restoring intestinal continuity. At the post-catumaxomab surgery 7 patients presented massive intraoperative adhesion grade 3 (score system 0-3), while 3 patients developed repeated abscesses. Four out of the six patients operated due to recurrent EOC, presented extensive tumor load with severe peritoneal carcinosis. Nevertheless, none of the relapsed patients had at surgery ascites >500 ml. Surgery after i.p. catumaxomab appears feasible, however, larger prospective evaluations are warranted to assess its true impact on adhesion formation and postoperative morbidity.
    Anticancer research 08/2011; 31(8):2603-8. · 1.87 Impact Factor