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| 1 | Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma显示文摘Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments Ⅱ through Ⅵ, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects. | Ioannis A Ziogas Georgios Tsoulfas | 2017 | World Journal of Gastrointestinal Surgery2017，9，12： | 10 |
| 2 | Surgical treatment of hepatic metastases from colorectal cancer显示文摘Colorectal carcinoma is one of the most frequent cancers in Western societies with an incidence of around 700 per million people.About half of the patients develop metastases from the primary tumor and liver is the primary metastatic site.Improved survival rates after hepatectomy for metastatic colorectal cancer have been reported in the last few years and these may be the result of a variety of factors,such as advances in systemic chemotherapy,radiographic imaging techniques that permit more accurate determination of the extent and location of the metastatic burden,local ablation methods,and in surgical techniques of hepatic resection.These have led to a more aggressive approach towards liver metastatic disease,resulting in longer survival.The goal of this paper is to review the role of various forms of surgery in the treatment of hepatic metastases from colorectal cancer. | Georgios Tsoulfas Manousos Georgios Pramateftakis Ioannis Kanellos | 2011 | World Journal of Gastrointestinal Oncology2011，3，1： | 7 |
| 3 | Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology显示文摘Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated fields.Machine learning(ML)refers to a model that learns from past data to predict future data.Medicine and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software applications.In this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application.Specifically,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing cholangitis.At the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them.Notably,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and transparency.Even at a slower pace than anticipated,AI is infiltrating the healthcare industry.AI in healthcare will become a reality,and every physician will have to engage with it by necessity. | Chrysanthos D Christou Georgios Tsoulfas | 2021 | World Journal of Gastroenterology2021，27，37： | 5 |
| 4 | Evolving role of Sorafenib in the management of hepatocellular carcinoma显示文摘Hepatocellular carcinoma(HCC) is one of the most common malignant diseases worldwide and comes third in cancer-related mortality.Although there is a broad spectrum of treatment options to choose from,only a few patients are eligible candidates to receive a curative therapy according to their stage of disease,and thus palliative treatment is implemented in the majority of the patients suffering from liver cancer.Sorafenib,a multikinase inhibitor,is the only currently approved agent for systemic therapy in patients with advanced stage HCC and early stage liver disease.It has been shown to improve the overall survival,but with various side effects,while its cost is not negligible.Sorafenib has been in the market for a decade and has set the stage for personalized targeted therapy.Its role during this time has ranged from monotherapy to neoadjuvant and adjuvant treatment with surgical resection,liver transplantation and chemoembolization or even in combination with other chemotherapeutic agents.In this review our aim is to highlight in depth the current position of Sorafenib in the armamentarium against HCC and how that has evolved over time in its use either as a single agent or in combination with other therapies. | Ioannis A Ziogas Georgios Tsoulfas | 2017 | World Journal of Clinical Oncology2017，8，3： | 4 |
| 5 | Enhanced recovery after surgery in liver transplantation:Challenges and feasibility显示文摘BACKGROUND Enhanced recovery after surgery(ERAS)started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient.In the last decade,ERAS has gained significant acceptance in the community of general surgery,in addition to several other surgical specialties,as the evidence of its advantages continues to grow.One of the last remaining fields,given its significant complexity and intricate nature,is liver transplantation(LT).AIM To investigate the existing efforts at implementing ERAS in LT.METHODS We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT,with a multimodal approach and focusing on measurable clinical primary endpoints,namely length of hospital stay.RESULTS All studies demonstrated a considerable decrease in length of hospital stay,with no readmission or negative impact of the ERAS protocol applied to the postoperative course.CONCLUSIONS ERAS is a well-validated multimodal approach for almost all types of surgical procedures,and its future in selected LT patients seems promising,as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT. | Georgios Katsanos Konstantina-Eleni Karakasi Nikolaos Antoniadis Stella Vasileiadou Athanasios Kofinas Antonios Morsi-Yeroyannis Evangelia Michailidou Ioannis Goulis Emmanouil Sinakos Olga Giouleme Ilias Marios Oikonomou George Evlavis Georgios Tsakiris Eleni Massa Eleni Mouloudi Georgios Tsoulfas | 2022 | World Journal of Transplantation2022，12，7： | 3 |
| 6 | Role of three-dimensional printing and artificial intelligence in the management of hepatocellular carcinoma:Challenges and opportunities显示文摘Hepatocellular carcinoma(HCC)constitutes the fifth most frequent malignancy worldwide and the third most frequent cause of cancer-related deaths.Currently,treatment selection is based on the stage of the disease.Emerging fields such as three-dimensional(3D)printing,3D bioprinting,artificial intelligence(AI),and machine learning(ML)could lead to evidence-based,individualized management of HCC.In this review,we comprehensively report the current applications of 3D printing,3D bioprinting,and AI/ML-based models in HCC management;we outline the significant challenges to the broad use of these novel technologies in the clinical setting with the goal of identifying means to overcome them,and finally,we discuss the opportunities that arise from these applications.Notably,regarding 3D printing and bioprinting-related challenges,we elaborate on cost and cost-effectiveness,cell sourcing,cell viability,safety,accessibility,regulation,and legal and ethical concerns.Similarly,regarding AI/ML-related challenges,we elaborate on intellectual property,liability,intrinsic biases,data protection,cybersecurity,ethical challenges,and transparency.Our findings show that AI and 3D printing applications in HCC management and healthcare,in general,are steadily expanding;thus,these technologies will be integrated into the clinical setting sooner or later.Therefore,we believe that physicians need to become familiar with these technologies and prepare to engage with them constructively. | Chrysanthos D Christou Georgios Tsoulfas | 2022 | World Journal of Gastrointestinal Oncology2022，14，4： | 2 |
| 7 | Role of innovative 3D printing models in the management of hepatobiliary malignancies显示文摘Three-dimensional (3D) printing has recently emerged as a new technique in various liver-related surgical fields. There are currently only a few systematic reviews that summarize the evidence of its impact. In order to construct a systematic literature review of the applications and effects of 3D printing in liver surgery, we searched the PubMed, Embase and ScienceDirect databases for relevant titles, according to the PRISMA statement guidelines. We retrieved 162 titles, of which 32 met the inclusion criteria and are reported. The leading application of 3D printing in liver surgery is for preoperative planning. 3D printing techniques seem to be beneficial for preoperative planning and educational tools, despite their cost and time requirements, but this conclusion must be confirmed by additional randomized controlled trials. | Peter Bangeas Vassilios Tsioukas Vasileios N Papadopoulos Georgios Tsoulfas | 2019 | World Journal of Hepatology2019，11，7： | 2 |
| 8 | Hepatocellular carcinoma and metabolic syndrome: The times are changing and so should we显示文摘Although hepatocellular carcinoma (HCC) is as prevalent as ever as a cancerrelated mortality, and some would even argue that it is increasing, the pattern of its etiologies has been changing. Specifically, the domination of viral hepatitis C virus is being overcome, partly because of the emergence of the antiviral treatments, and partly because of the significant increase, especially in developed countries, of the combination of obesity, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and non-alcoholic steatohepatitis. This editorial will explore the interconnection of this group of diseases and how they are linked to HCC. More importantly, it will argue that this shift in HCC etiology essentially means that we have to change how we approach the treatment of HCC, by changing our focus (and resources) to earlier stages of the disease development in order to prevent the appearance and progression of HCC. | Georgios Tsoulfas | 2019 | World Journal of Gastroenterology2019，25，29： | 2 |
| 9 | Detection of human papillomavirus DNA in esophageal carcinoma in Greece显示文摘AIM:To detect human papillomavirus(HPV)in theesophageal mucosa and the possible relationship with esophageal cancer in Greece.METHODS:Forty-nine patients underwent esophagogastroduodenoscopy(EGD)and esophageal biopsy at a university hospital that acts as a referral center for Northern Greece.Nineteen of these patients(14 male and 5 female)had esophageal squamous cell carcinoma(ESCC)and 30(15 male and 15 female)did not have any reported esophageal malignancy.Histopathological assessment was followed by polymerase chain reaction analysis of all the samples.Patient demographic data(age,sex,and place of birth)and information regarding smoking habits,alcohol consumption or sexual habits were collected.A method of statistical interference,verification of hypotheses based on homogeneity and independentχ2 test,was used.RESULTS:From the 49 patients that underwent EGD and biopsy,19 had ESCC and 30 had normal esophageal mucosa,with a mean age of 65.2 years.Regarding the prevalence of oncogenic risk factors for esophageal carcinoma,an interesting conclusion was that 78%of the patients used tobacco and almost one-third had multiple sexual partners,whereas only 20%of the patients consumed alcohol,which was not statistically significant,when compared to the control group.In the ESCC group,the only two positive samples were among the male patients(2/14 male patients with ESCC,14.5%).No HPV was identified in the control group.The predominant HPV types identified were 11 and 31,which have a low malignancy potential.The presence of HPV DNA in the ESCC group was not statistically significant,95%confidence interval(χ2=3.292,P=0.07).CONCLUSION:This is the first relevant study in Greece,and despite the lack of statistical significance,the issue of HPV infection and ESCC does merit further investigation. | Georgios Georgantis Theodoros Syrakos Theodoros Agorastos Spiridon Miliaras Asterios Gagalis Georgios Tsoulfas Konstantinos Spanos Georgios Marakis | 2015 | World Journal of Gastroenterology2015，21，8： | 2 |
| 10 | Surgical treatment for large hepatocellular carcinoma: does size matter?显示文摘 | Georgios Tsoulfas Alexandros Mekras Polyxeni Agorastou Dimitrios Kiskinis | 2012 | ANZ Journal of Surgery . 2012 (7‐8)2012，，7： | 1 |
| 11 | Survival outcomes in liver transplantation for hepatocellular carcinoma, comparing impact of hepatitis C versus other etiology of cirrhosis显示文摘 | Adel Bozorgzadeh Mark Orloff Peter Abt Georgios Tsoulfas Durald Younan Randeep Kashyap Ashok Jain Parvez Mantry Benedict Maliakkal Alok Khorana Seymour Schwartz | 2007 | Liver Transpl2007，，6： | 1 |
| 12 | Stratifying Risk of Biliary Complications in Adult Living Donor Liver Transplantation by Magnetic Resonance Cholangiography显示文摘 | Randeep Kashyap Adel Bozorgzadeh Peter Abt Georgios Tsoulfas Manoj Maloo Rajeev Sharma Siddharth Patel David Dombroski Parvez Mantry Saman Safadjou Ashok Jain Mark Orloff | 2008 | Transplantation2008，，11： | 1 |
| 13 | Laparoscopic vs open donor nephrectomy:Lessons learnt from single academic center experience显示文摘AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor. | Georgios Tsoulfas Polyxeni Agorastou Dicken SC Ko Martin Hertl Nahel Elias AB Cosimi Tatsuo Kawai | 2017 | World Journal of Nephrology2017，6，1： | 1 |
| 14 | Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!显示文摘Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare,cost,and quality of life associated consequences.MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease.Conservative treatment,which includes diet,exercise,and antidiabetic agents,is the mainstay of treatment,but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations.Bariatric surgery has recently emerged as an appropriate alternative treatment with promising longterm results.Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates.Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with nonalcoholic steatohepatitis has increased more than fivefold over the past 15 years.In this review,we summarize current state of evidence on the surgical treatment of MS. | Ioannis A Ziogas Konstantinos Zapsalis Dimitrios Giannis Georgios Tsoulfas | 2020 | World Journal of Hepatology2020，12，10： | 1 |
| 15 | The Cumulative Effects of Cold Ischemic Time and Older Donor Age on Liver Graft Survival显示文摘 | James R. Cassuto Siddharth A. Patel Georgios Tsoulfas Mark S. Orloff Peter L. Abt | 2008 | Journal of Surgical Research2008，，1： | 1 |
| 16 | Stratifying Risk of Biliary Complications in Adult Living Donor Liver Transplantation by Magnetic Resonance Cholangiography显示文摘 | Randeep Kashyap Adel Bozorgzadeh Peter Abt Georgios Tsoulfas Manoj Maloo Rajeev Sharma Siddharth Patel David Dombroski Parvez Mantry Saman Safadjou Ashok Jain Mark Orloff | 2008 | Transplantation2008，，11： | 1 |
| 17 | Immunohistochemical Detection of Cancer Stem Cell Related Markers CD44 and CD133 in Metastatic Colorectal Cancer Patients显示文摘 | Pavel Pitule Miroslava Cedikova Ondrej Daum Jan Vojtisek Ondrej Vycital Petr Hosek Vladislav Treska Ondrej Hes Milena Kralickova Vaclav Liska Georgios Tsoulfas | 2014 | BioMed Research International2014，，： | 1 |
| 18 | Effect of panel reactive antibodies on T cell immunity reinstatement following renal transplantation显示文摘BACKGROUND Chronic kidney disease is associated with immunological disorders,presented as phenotypic alterations of T lymphocytes.These changes are expected to be restored after a successful renal transplantation;however,additional parameters may contribute to this process.AIM To evaluate the impact of positive panel reactive antibodies(PRAs)on the restoration of T cell phenotype,after renal transplantation.METHODS CD4CD28null,CD8CD28null,natural killer cells(NKs),and regulatory T cells(Tregs)were estimated by flow cytometry at T0,T3,and T6 which were the time of transplantation,and 3-and 6-mo follow-up,respectively.Changes were estimated regarding the presence or absence of PRAs.RESULTS Patients were classified in two groups:PRA(-)(n=43)and PRA(+)(n=28)groups.Lymphocyte and their subtypes were similar between the two groups at T0,whereas their percentage was increased at T3 in PRA(-)compared to PRA(+)[23(10.9-47.9)vs 16.4(7.5-36.8)μ/L,respectively;P=0.03].Lymphocyte changes in PRA(-)patients included a significant increase in CD4 cells(P<0.0001),CD8 cells(P<0.0001),and Tregs(P<0.0001),and a reduction of NKs(P<0.0001).PRA(+)patients showed an increase in CD4(P=0.008)and CD8(P=0.0001),and a reduction in NKs(P=0.07).CD4CD28null and CD8CD28null cells,although initially reduced in both groups,were stabilized thereafter.CONCLUSION Our study described important differences in the immune response between PRA(+)and PRA(-)patients with changes in lymphocytes and lymphocyte subpopulations.PRA(+)patients seemed to have a worse immune profile after 6 mo follow-up,regardless of renal function. | Lampros Vagiotas Maria Stangou Efstratios Kasimatis Aliki Xochelli Grigorios Myserlis Georgios Lioulios Vasiliki Nikolaidou Manolis Panteli Konstantinos Ouranos Nikolaos Antoniadis Daoudaki Maria Aikaterini Papagianni Georgios Tsoulfas Asimina Fylaktou | 2022 | World Journal of Transplantation2022，12，10： | 0 |
| 19 | Global dissemination of minimally invasive living donor hepatectomy: What are the barriers?显示文摘Minimally invasive donor hepatectomy(MIDH)is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors.After an initial period in which donor safety was not effectively validated,MIDH currently seems to provide improved results,provided that it is conducted by experienced surgeons.Appropriate selection criteria are crucial to achieve better outcomes in terms of complications,blood loss,operative time,and hospital stay.Beyond a pure laparoscopic technique,various approaches have been recommended such as hand-assisted,laparoscopic-assisted,and robotic donation.The latter has shown equal outcomes compared to open and laparoscopic approaches.A steep learning curve seems to exist in MIDH,mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding.This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination.Surgeons need expertise in liver transplantation,hepatobiliary surgery,and minimally invasive techniques to perform MIDH.Barriers can be categorized into surgeon-related,institutionalrelated,and accessibility.More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide. | Christos Dimitrios Kakos Angelos Papanikolaou Ioannis A Ziogas Georgios Tsoulfas | 2023 | World Journal of Gastrointestinal Surgery2023，15，5： | 0 |
| 20 | Obstetrical and gynecologic challenges in the liver transplant patient显示文摘An increasing number of childbearing agewomen undergo liver transplantation(LT)in the United States.Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility,particularly in terms of immunosuppression and optimal timing of conception.Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus.On the other hand,the outcomes of pregnancy in LT recipients are favorable,and children born to LT recipients are relatively healthy.Counseling on pregnancy should start before LT and continue after LT up until pregnancy,while all pregnant LT recipients must be managed by amultidisciplinary team,including both an obstetrician and a transplant hepatologist.Additionally,an interval of at least 1-2 years after successful LT is recommended before considering pregnancy.Pregnancy-induced hypertension,pre-eclampsia,and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients.As adverse fetal outcomes,such asmiscarriage,abortion,stillbirth,or ectopic pregnancy,may occur more often than in the non-transplant population,early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications.No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients. | Ioannis A Ziogas Muhammad H Hayat Georgios Tsoulfas | 2020 | World Journal of Transplantation2020，10，11： | 0 |
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