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Conference Presentations by Evangelos Prassas

Hepatic resection has emerged as an effective treatment for secondary liver neuroendocrine tumour... more Hepatic resection has emerged as an effective treatment for secondary liver neuroendocrine tumours. ‘Associated liver partition and portal vein ligation for staged hepatectomy’ (ALPPS) allows resection of liver tumours in two steps. We present our experience in ALPPS procedure as a method which can minimise small for size syndrome, and provide an oncological benefit to borderline resectable neuroendocrine tumours within acceptable safety profile.

Papers by Evangelos Prassas

Journal of the Pancreas, 2016

Pancreatic cancer is a malignancy with overall poor prognosis. Surgery is the only treatment moda... more Pancreatic cancer is a malignancy with overall poor prognosis. Surgery is the only treatment modality, which could provide cure. Therefore every effort possible should be made for pancreatectomy to achieve R0 resection. However, even after R0 resection, the survival outcomes are still far behind from other solid intrabdominal tumors. Extended lymphadenectomy and “mesopancreas” excision are the two main factors where focus has been given, in order to improve the outcomes of pancreatectomy for pancreatic head cancer. We present an up to date comprehensive review of the current evidence on the topics of extended lymphadenectomy and “mesopancreas” excision during pancreatoduodenectomy for cancer.

HPB, 2020

comparing the bilobar group tot he control group (1year: 96% in both groups and 5year 76%bilobar ... more comparing the bilobar group tot he control group (1year: 96% in both groups and 5year 76%bilobar vs 66%,p=0.80) and disease free survuval was similar (1year: 64% vs 73%, 3year: 38 vs 42%, 5year: 38% vs 28%). Conclusion: In experienced hands LLR for bCRLM can be performed safely with similar oncologic outcomes as patients who underwent a single laparoscopic resection for CRLM.

Liver, 2018

indices of functional decline in determining transplantation outcome in patients with cirrhosis. ... more indices of functional decline in determining transplantation outcome in patients with cirrhosis. Methods Twenty-eight consecutive patients (mean [range] age 52 [29-66] yr; 75% men; four (14.3%) alcohol-related; mean MELD 13.2 [7-30]) transplanted for end stage liver disease/ HCC were included. All were assessed pre-transplantation, as follows: disease severity: MELD and Child Pugh (CP); nutritional status: The Royal Free Hospital-Nutritional Prioritising Tool; HRQOL: Chronic Liver Disease Questionnaire and Euro Quol-5 Dimension Tool; mental health: Beck Anxiety and Depression Indices; disability: Activities (ADL) and Independent Activities of Daily Living (IADL); and frailty: Clinical Frailty Scale, Short Physical Performance Battery and Fried Frailty Criteria plus two composite instruments, the Bristol Prognostic Index and Karnofsky Age MELD Model. Variables associated with the primary outcome (death/retransplantation) were identified using Cox regression analysis. Variables associated with secondary outcomes, including the total units of blood transfused and the length of hospital stay, were identified using linear regression analysis. Results Patients were followed for a mean of 143 [3-326] days; two (7.1%) died and four (14.3%) were retransplanted. IADL was the only tool significantly associated with mortality in this cohort. Each unit increase in the IADL (decreasing frailty) was associated with a 45% decrease in mortality after adjustment for MELD (Hazard Ratio (HR) 0.55, 95% CI, 0.33-0.92). The total mean LOHS was 28 [7-112] days. The CP score was significantly associated with LOHS (F(1, 25) =6.01, p=0.02, R 2 =0.19); each unit increase in CP was associated with an increase in LOHS of 6.5 days. The mean units of blood transfused was 46 [3-178]; The amount transfused increased by 11.33 (p=0.03) and 4.2 (p=0.01) units for each unit increase in CP and MELD scores respectively. Conclusions Disease severity and functional decline, characterised by the IADL score are significantly associated with short to medium term transplant outcomes in this cohort. Longerterm follow is required to validate these Results.

Pancreas, 2018

Conclusions Our study indicates that EUS FNA microcore biopsy is more sensitive than endobiliary ... more Conclusions Our study indicates that EUS FNA microcore biopsy is more sensitive than endobiliary biopsy in the diagnosis of malignant pancreaticobiliary lesions. Because lesions are visualised, sampling is targeted and this provides high tissue yield enabling a malignant histological diagnosis to be rendered and reduces the need for repeated sampling. The tissue sample is also amenable to immunohistochemical staining which is important in characterising suspected metastases. EUS FNA microcore biopsy has been demonstrated to be useful in sampling suspected primary biliary neoplasm. As such, we believe that EUS FNA should be the standard method of tissue sampling in suspected malignant pancreaticobiliary lesions.

HPB, 2018

The use of day one drain-fluid-amylase (DFA-1) to predict post-operative pancreatic fistula (POPF... more The use of day one drain-fluid-amylase (DFA-1) to predict post-operative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) remains controversial. We aim to assess the significance of a DFA-1 level of 5000 U/L. Methods: The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) pancreatectomy targeted files were queried from 2014e2016 to identify patients who underwent PD. Only patients with a recorded DFA-1 level were included for analysis. DFA-1 was recorded as a dichotomous variable using the cut off of less or greater than 5000 U/L. A Receiver Operator Characteristic (ROC) curve was plotted to determine the optimal DFA-1 to predict fistula formation. Results: We identified a total of 9432 cases of PD, of which only 2545 (27%) had a postoperative DFA-1 level recorded. A fistula was recorded in 410 (16.2%) consisting of 277 (67.5%) A and 133 (32.5%) B/C grade fistulae. A postoperative DFA-1 level of 5000 U/L significantly correlates with development of a grade B/C pancreatic fistula with a specificity of 84.4% and sensitivity of 32.3% (positive predictive value of 10.3% and negative predictive value of 95.7%). The area under the curve for B/C was 0.792 (p < 0.001) setting a specificity of 80%, the ROC curve demonstrated that a cutoff value of 800 U/L, provided a sensitivity of 68.6%. Conclusion: The DFA-1 value of 5000 U/L is statistically significant of fistula development post PD, however its sensitivity is poor. The ROC determined value of 800 U/L would appear to be a more appropriate level for detection of B/C fistulae.

International Journal of Surgery, 2015

Aim: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone diseas... more Aim: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease. The internet provides a vast information source that patients can access. It is imperative that the information relating to the procedure be accurate, relevant and understandable. Methods: We identified 125 websites from searching "laparoscopic cholecystectomy" in the 5 most popular internet search engines. The websites were examined for readability by measuring the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, and the Gunning-Fog Index. The quality of the websites was measured by the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmark criteria, and Health on the Net Foundation (HON) certification. Results: Overall, the quality was poor with the average DISCERN score being only 32.72(0-80). The mean reading grade level was 9 (recommended level-6). HON certification did correspond to significantly worse readability scores. Those that satisfied more of the JAMA benchmark criteria had significantly better DISCERN scores (P<.001) Conclusion: Information relating to the laparoscopic cholecystectomy procedure is of a low standard and is in many cases written at too high a level for the general population. We, as surgeons have a responsibility to recommend accurate patient centred websites and thus ensure patients receive reliable information regarding their condition and treatment options.

Hepatobiliary & Pancreatic Diseases International, 2019

European Journal of Surgical Oncology