Gregor Stavrou - Academia.edu (original) (raw)
Papers by Gregor Stavrou
Zeitschrift für Gastroenterologie, 2012
![Research paper thumbnail of [Hormone inactive parathyroid cyst: rare differential diagnosis in the evaluation of cervical cysts]](https://attachments.academia-assets.com/42382950/thumbnails/1.jpg)
](Zentralblatt für Chirurgie
Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearme... more Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearmedizinisch-endokrinologischer Behandlung. Er klagte über ein progredientes Druckgefühl im Hals. Bei zunehmender Dyspnoe war eine gut palpable, zystische Struktur kaudal des rechten Schilddrüsenlappens aufgefal-len, die sonografisch bis in den Thorax reichte und mehrfach punktiert wurde. Hierbei konnten jeweils bis zu 50 ml einer klaren serösen Flüssigkeit gewonnen werden. Da die Punktion jedoch nur kurzfristig Symptombesserung erreichen konnte und die Zyste persistierte, wurde eine chirurgische Therapie angestrebt. Klinisch und anamnestisch ergab sich kein Anhalt für Symptome eines Hyperparathyreoidismus.
Zentralblatt für Chirurgie
Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearme... more Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearmedizinisch-endokrinologischer Behandlung. Er klagte über ein progredientes Druckgefühl im Hals. Bei zunehmender Dyspnoe war eine gut palpable, zystische Struktur kaudal des rechten Schilddrüsenlappens aufgefal-len, die sonografisch bis in den Thorax reichte und mehrfach punktiert wurde. Hierbei konnten jeweils bis zu 50 ml einer klaren serösen Flüssigkeit gewonnen werden. Da die Punktion jedoch nur kurzfristig Symptombesserung erreichen konnte und die Zyste persistierte, wurde eine chirurgische Therapie angestrebt. Klinisch und anamnestisch ergab sich kein Anhalt für Symptome eines Hyperparathyreoidismus.
![Research paper thumbnail of [Liver resection (part I) -- anatomical basis, indication, and preoperative planning]](https://attachments.academia-assets.com/42382949/thumbnails/1.jpg)
](Zentralblatt für Chirurgie
Die Chirurgie der Leber hat sich in den letzten Jahren stetig weiterentwickelt .
![Research paper thumbnail of [Innovative application of radiofrequency in hepatic surgery. Preliminary experience]](https://attachments.academia-assets.com/42382948/thumbnails/1.jpg)
](Chirurgia italiana
La chirurgia epatica è stata soggetta negli ultimi anni a numerose trasformazioni attraverso l'im... more La chirurgia epatica è stata soggetta negli ultimi anni a numerose trasformazioni attraverso l'impiego di nuove tecnologie, rappresentando ancora il trattamento principe nella terapia dei tumori epatici. Al giorno d'oggi l'evoluzione delle tecniche chirurgiche e delle nuove applicazioni tecnologiche consente di eseguire anche le resezioni epatiche allargate, con un certo grado di sicurezza in centri dedicati 1-3 . La riduzione della morbilità e della mortalità postoperatoria è il frutto di avanzamenti come la chirurgia in ipotensione, l'esclusione vascolare ed il miglioramento dei "device" applicati in fase resettiva. La termoablazione nel trattamento delle metastasi epatiche possiede ormai un'ampia diffu-
We are describing the conceptual design and prototypic implementation of a training system for sp... more We are describing the conceptual design and prototypic implementation of a training system for spine surgery. Based on real case data the SPINESURGERYTRAINER shall impart cognitive strategies for decisions on effective therapy and possible therapy variations as well as anatomical knowledge and interaction techniques for the computer-based planning of therapies for spinal diseases. To understand the requirements of future users and to establish a common basis for communication between surgeons and developers we used the informal specification method of scenarios for the whole design process of our system.
World journal of surgical oncology, 2015
Resection of the liver is often limited due to the volume of the parenchyma. To address this prob... more Resection of the liver is often limited due to the volume of the parenchyma. To address this problem, several approaches to induce hypertrophy were developed. Recently, the 'associating liver partition and portal vein ligation for staged hepatectomy' (ALPPS) procedure was introduced and led to rapid hypertrophy in a short interval. Additionally to the portal vein occlusion, the parenchyma is transected, which disrupts the inter-parenchymal vascular connections. Since the first description of the ALPPS procedure, various reports around the world were published. In some cases, due to the high morbidity and mortality, a decent oncologic algorithm is not deliverable in a timely manner. If a patient is to be treated with a liver-first approach, the resection of the primary could sometimes be severely protracted. To overcome the problem, a simultaneous resection of the primary tumor and step one of ALPPS were performed. A 73-year-old male patient underwent portal vein embolization...
Zentralblatt für Chirurgie, 2006
Future oncology (London, England), 2015
The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage... more The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage IV colorectal cancer patients and complete the therapeutic plan. From then some groups have used this new revolutionary approach reporting promising results. Other alternative strategies have been proposed for metastatic patients. The authors reviewed the literature weighing the pros and cons of each strategy proposed to manage these advanced tumor stages. The therapeutic options are analyzed in the light of oncologic problems and evidence. Also problems, questions and perspectives are given. Even if the 'liver-first' approach seems to be a promising strategy, the ideal diagnostic-therapeutic flowchart for metastatic colorectal cancer is still difficult to standardize. The great heterogeneity of this population of patients is one of the main problems. A 'tailored approach' philosophy is necessary to calibrate, in a multidisciplinary setting, a case-by-case choice of ther...
Journal of hepato-biliary-pancreatic sciences, Jan 28, 2011
BACKGROUND: The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknow... more BACKGROUND: The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases. METHODS: A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures. RESULTS: A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged <40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred...
La Clinica terapeutica, 2010
With advances in laparoscopic surgery, laparoscopic deroofing has gained wide acceptance in the s... more With advances in laparoscopic surgery, laparoscopic deroofing has gained wide acceptance in the surgical community to treat symptomatic non-parasitic hepatic cysts. Published non-surgical data still favour aspiration and sclerotherapy as treatment in these cases, though morbidity is higher and recurrence rates are not acceptable. We reviewed all patients that had been treated by laparoscopic deroofing in our department over a period of 6 years in order to find out if the surgical approach should be considered the standard treatment. Over a 6 year period, 34 laparoscopic deroofings were performed in 21 patients with symptomatic cysts. Patients underwent laparoscopy followed by radical deroofing using an Ultracision device. All cases were completed laparoscopically, no intraoperative adverse events were recorded. Mean operation time was 101 ± 22.7 min. The mean size of treated cysts was 9.7 ± 2.18 cm. Follow up showed only one symptomatic recurrence (3.3%) two months after surgery. La...
International surgery
The importance of multimodal treatment for advanced esophago-gastric cancer has contributed to th... more The importance of multimodal treatment for advanced esophago-gastric cancer has contributed to the development of more accurate preoperative staging strategies. The impact of staging laparoscopy and cytology after conventional staging is evaluated in this study. Staging laparoscopy was performed in 125 patients with potentially resectable cancer of the distal esophagus or gastric cancer. Results were registered separately on a database according to the TNM classification of the International Union Against Cancer (UICC). Laparoscopy changed TNM classification in 46 cases. Explorative laparoscopy resulted in up-staging concerning the N-factor (n = 15) and M-factor (n = 28). Downstaging of the T-factor was recorded in three cases. Cytologic examination gave no additional information in our series. Our experience suggests a clear benefit of laparoscopy in staging of patients with distal esophagus or gastric malignancy. Laparoscopy is a safe and effective staging modality, avoiding unnec...
Zentralblatt für Chirurgie, 2006
Übersicht Übersicht und Einleitung Im ersten Teil der vorliegenden Serie wurden die anatomischen ... more Übersicht Übersicht und Einleitung Im ersten Teil der vorliegenden Serie wurden die anatomischen Grundlagen, die Indikation und die prä operative Planung vor einer Leberresektion behandelt und in Bezug zur aktuellen Datenlage gebracht. Im Folgenden soll nun auf die verschiedenen Schritte bei der Durchfü hrung einer Leberresektion eingegangen werden, insbesondere sollen die intraoperative Strategie, die jeweils notwendige Prä paration und die verschiedenen Verfahren zur Parenchymdissektion betrachtet werden. Seitdem die Hö he des intraoperativen Blutverlustes und des Transfusionsbedarfes als einzelner hochsignifikanter Parameter fü r das operative Ergebnis und fü r das Ü berleben der Patienten erkannt wurde [14, 28, 69, 72], richtet sich die moderne Leberchirurgie auf eine parenchymsparende und mö glichst blutungsarme Operationstechnik aus. Dies hat zu einer enormen Senkung der mit der Resektion assoziierten Mortalitä t auf 2-4 % gefü hrt, sodass man heute an spezialisierten Zentren von einer sicheren und standardisierten Operation sprechen kann. In Anbetracht der technischen Fortschritte werden bei Resektionen von Lebermetastasen 5-Jahres-Ü berlebensraten von 25-37 % berichtet [20, 27, 47, 63, 66]. Es wurden auch schon 5-Jahres-Ü berlebensraten von 60 % postuliert [32]. Einige Autoren berichten sogar von einer 10-Jahres-Ü berlebensrate von 20-22 % [20, 29, 63]. Fü r die Patientenpopula-
Zeitschrift für Gastroenterologie, 2012
Zentralblatt für Chirurgie
Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearme... more Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearmedizinisch-endokrinologischer Behandlung. Er klagte über ein progredientes Druckgefühl im Hals. Bei zunehmender Dyspnoe war eine gut palpable, zystische Struktur kaudal des rechten Schilddrüsenlappens aufgefal-len, die sonografisch bis in den Thorax reichte und mehrfach punktiert wurde. Hierbei konnten jeweils bis zu 50 ml einer klaren serösen Flüssigkeit gewonnen werden. Da die Punktion jedoch nur kurzfristig Symptombesserung erreichen konnte und die Zyste persistierte, wurde eine chirurgische Therapie angestrebt. Klinisch und anamnestisch ergab sich kein Anhalt für Symptome eines Hyperparathyreoidismus.
Zentralblatt für Chirurgie
Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearme... more Der 57-jährige, bisher internistisch gesunde Patient, war über 9 Monate vor Aufnahme in nuklearmedizinisch-endokrinologischer Behandlung. Er klagte über ein progredientes Druckgefühl im Hals. Bei zunehmender Dyspnoe war eine gut palpable, zystische Struktur kaudal des rechten Schilddrüsenlappens aufgefal-len, die sonografisch bis in den Thorax reichte und mehrfach punktiert wurde. Hierbei konnten jeweils bis zu 50 ml einer klaren serösen Flüssigkeit gewonnen werden. Da die Punktion jedoch nur kurzfristig Symptombesserung erreichen konnte und die Zyste persistierte, wurde eine chirurgische Therapie angestrebt. Klinisch und anamnestisch ergab sich kein Anhalt für Symptome eines Hyperparathyreoidismus.
Zentralblatt für Chirurgie
Die Chirurgie der Leber hat sich in den letzten Jahren stetig weiterentwickelt .
Chirurgia italiana
La chirurgia epatica è stata soggetta negli ultimi anni a numerose trasformazioni attraverso l'im... more La chirurgia epatica è stata soggetta negli ultimi anni a numerose trasformazioni attraverso l'impiego di nuove tecnologie, rappresentando ancora il trattamento principe nella terapia dei tumori epatici. Al giorno d'oggi l'evoluzione delle tecniche chirurgiche e delle nuove applicazioni tecnologiche consente di eseguire anche le resezioni epatiche allargate, con un certo grado di sicurezza in centri dedicati 1-3 . La riduzione della morbilità e della mortalità postoperatoria è il frutto di avanzamenti come la chirurgia in ipotensione, l'esclusione vascolare ed il miglioramento dei "device" applicati in fase resettiva. La termoablazione nel trattamento delle metastasi epatiche possiede ormai un'ampia diffu-
We are describing the conceptual design and prototypic implementation of a training system for sp... more We are describing the conceptual design and prototypic implementation of a training system for spine surgery. Based on real case data the SPINESURGERYTRAINER shall impart cognitive strategies for decisions on effective therapy and possible therapy variations as well as anatomical knowledge and interaction techniques for the computer-based planning of therapies for spinal diseases. To understand the requirements of future users and to establish a common basis for communication between surgeons and developers we used the informal specification method of scenarios for the whole design process of our system.
World journal of surgical oncology, 2015
Resection of the liver is often limited due to the volume of the parenchyma. To address this prob... more Resection of the liver is often limited due to the volume of the parenchyma. To address this problem, several approaches to induce hypertrophy were developed. Recently, the 'associating liver partition and portal vein ligation for staged hepatectomy' (ALPPS) procedure was introduced and led to rapid hypertrophy in a short interval. Additionally to the portal vein occlusion, the parenchyma is transected, which disrupts the inter-parenchymal vascular connections. Since the first description of the ALPPS procedure, various reports around the world were published. In some cases, due to the high morbidity and mortality, a decent oncologic algorithm is not deliverable in a timely manner. If a patient is to be treated with a liver-first approach, the resection of the primary could sometimes be severely protracted. To overcome the problem, a simultaneous resection of the primary tumor and step one of ALPPS were performed. A 73-year-old male patient underwent portal vein embolization...
Zentralblatt für Chirurgie, 2006
Future oncology (London, England), 2015
The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage... more The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage IV colorectal cancer patients and complete the therapeutic plan. From then some groups have used this new revolutionary approach reporting promising results. Other alternative strategies have been proposed for metastatic patients. The authors reviewed the literature weighing the pros and cons of each strategy proposed to manage these advanced tumor stages. The therapeutic options are analyzed in the light of oncologic problems and evidence. Also problems, questions and perspectives are given. Even if the 'liver-first' approach seems to be a promising strategy, the ideal diagnostic-therapeutic flowchart for metastatic colorectal cancer is still difficult to standardize. The great heterogeneity of this population of patients is one of the main problems. A 'tailored approach' philosophy is necessary to calibrate, in a multidisciplinary setting, a case-by-case choice of ther...
Journal of hepato-biliary-pancreatic sciences, Jan 28, 2011
BACKGROUND: The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknow... more BACKGROUND: The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases. METHODS: A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures. RESULTS: A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged <40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred...
La Clinica terapeutica, 2010
With advances in laparoscopic surgery, laparoscopic deroofing has gained wide acceptance in the s... more With advances in laparoscopic surgery, laparoscopic deroofing has gained wide acceptance in the surgical community to treat symptomatic non-parasitic hepatic cysts. Published non-surgical data still favour aspiration and sclerotherapy as treatment in these cases, though morbidity is higher and recurrence rates are not acceptable. We reviewed all patients that had been treated by laparoscopic deroofing in our department over a period of 6 years in order to find out if the surgical approach should be considered the standard treatment. Over a 6 year period, 34 laparoscopic deroofings were performed in 21 patients with symptomatic cysts. Patients underwent laparoscopy followed by radical deroofing using an Ultracision device. All cases were completed laparoscopically, no intraoperative adverse events were recorded. Mean operation time was 101 ± 22.7 min. The mean size of treated cysts was 9.7 ± 2.18 cm. Follow up showed only one symptomatic recurrence (3.3%) two months after surgery. La...
International surgery
The importance of multimodal treatment for advanced esophago-gastric cancer has contributed to th... more The importance of multimodal treatment for advanced esophago-gastric cancer has contributed to the development of more accurate preoperative staging strategies. The impact of staging laparoscopy and cytology after conventional staging is evaluated in this study. Staging laparoscopy was performed in 125 patients with potentially resectable cancer of the distal esophagus or gastric cancer. Results were registered separately on a database according to the TNM classification of the International Union Against Cancer (UICC). Laparoscopy changed TNM classification in 46 cases. Explorative laparoscopy resulted in up-staging concerning the N-factor (n = 15) and M-factor (n = 28). Downstaging of the T-factor was recorded in three cases. Cytologic examination gave no additional information in our series. Our experience suggests a clear benefit of laparoscopy in staging of patients with distal esophagus or gastric malignancy. Laparoscopy is a safe and effective staging modality, avoiding unnec...
Zentralblatt für Chirurgie, 2006
Übersicht Übersicht und Einleitung Im ersten Teil der vorliegenden Serie wurden die anatomischen ... more Übersicht Übersicht und Einleitung Im ersten Teil der vorliegenden Serie wurden die anatomischen Grundlagen, die Indikation und die prä operative Planung vor einer Leberresektion behandelt und in Bezug zur aktuellen Datenlage gebracht. Im Folgenden soll nun auf die verschiedenen Schritte bei der Durchfü hrung einer Leberresektion eingegangen werden, insbesondere sollen die intraoperative Strategie, die jeweils notwendige Prä paration und die verschiedenen Verfahren zur Parenchymdissektion betrachtet werden. Seitdem die Hö he des intraoperativen Blutverlustes und des Transfusionsbedarfes als einzelner hochsignifikanter Parameter fü r das operative Ergebnis und fü r das Ü berleben der Patienten erkannt wurde [14, 28, 69, 72], richtet sich die moderne Leberchirurgie auf eine parenchymsparende und mö glichst blutungsarme Operationstechnik aus. Dies hat zu einer enormen Senkung der mit der Resektion assoziierten Mortalitä t auf 2-4 % gefü hrt, sodass man heute an spezialisierten Zentren von einer sicheren und standardisierten Operation sprechen kann. In Anbetracht der technischen Fortschritte werden bei Resektionen von Lebermetastasen 5-Jahres-Ü berlebensraten von 25-37 % berichtet [20, 27, 47, 63, 66]. Es wurden auch schon 5-Jahres-Ü berlebensraten von 60 % postuliert [32]. Einige Autoren berichten sogar von einer 10-Jahres-Ü berlebensrate von 20-22 % [20, 29, 63]. Fü r die Patientenpopula-