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Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed.Methods and Materials: Between 1994 and 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with high-dose preoperative external beam irradiation, followed by extended surgery and intraoperative radiotherapy. To assess long-term functional outcome, all patients still alive (n = 97) were asked to complete a questionnaire regarding ongoing morbidity, as well as functional and social impairment. Seventy-six of the 79 patients (96%) returned the questionnaire. The median follow-up was 14 months (range: 4–60 months).Results: The questionnaire revealed fatigue in 44%, perineal pain in 42%, radiating pain in the leg(s) in 21%, walking difficulties in 36%, and voiding dysfunction in 42% of the patients as symptoms of ongoing morbidity. Functional impairment consisted of requiring help with basic activities in 15% and sexual inactivity in 56% of the respondents. Social handicap was demonstrated by loss of former lifestyle in 44% and loss of professional occupation in 40% of patients.Conclusions: As a result of multimodality treatment, the majority of these patients have to deal with long-term physical morbidity, the need for help with daily care, and considerable social impairment. These consequences must be weighed against the chance of cure if the patient is treated and the disability eventually caused by uncontrolled tumor progression if the patient is not treated. These potential drawbacks should be discussed with the patient preoperatively and taken into account when designing a treatment strategy. [Copyright &y& Elsevier]

Introduction Interest in bariatric surgery in adolescents is increasing, because adolescent obesity equals increased health risks in adult life. To define the preferred procedure in adolescents, this study compares outcomes of LSG and LRYGB in late adolescents in our center. Materials and methods Data on baseline characteristics, operative details, and follow-up were collected retrospectively in all patients (age 18-20 years) who underwent LSG or LRYGB in our clinic. Outcomes were analyzed using nonparametric tests. Results Total 65 adolescents (54 females; median age 19 years) were included, 45 patients underwent LSG, and 20 underwent LRYGB.Significant differences in %EWL were observed at 2-year follow-up; 81.0% in LRYGB (n = 11) versus 96.8% in LSG (n = 23), p = 0.007. No differences were observed in postoperative mortality, complication rate, and resolution of comorbidities between both procedures. Discussion LSG showed significant better results than LRYGB in terms of %EWL after 2 years in this selected group of late adolescents. Considering these results in LSG patients and the theoretical advantages of LSG (normal diet options, preservation of an intact GI-tract, less vitamin disturbances, and better quality of life), LSG may be an appropriate bariatric technique to perform in morbidly obese adolescents. [ABSTRACT FROM AUTHOR]

Background: Obesity is an increasing disease worldwide. Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold standard surgical technique. Laparoscopic Sleeve Gastrectomy (LSG) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract. The aim of this study is to evaluate the efficiency of both techniques. Our hypothesis is that LSG has a similar percentage excess BMI loss (%EBMIL) after 5 years compared to LRYGB. Methods/Design: The Sleeve Bypass Trial is a randomized multicentre clinical trial: patients eligible for bariatric surgery are randomized to either LSG or LRYGB. Patients with a body mass index (BMI) = 40 kg/m² or BMI 35 kg/m² with obesity related comorbidity (T2 DM, sleep apnoea, hypertension) are eligible for randomization. At randomization patients are stratified for centre, sex, T2 DM and BMI ≥ = 50 kg/m². A total number of 620 patients will be enrolled and equally (1:1) randomized to both treatment arms. Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial. The primary endpoint is the 5-year weight loss (%EBMIL) of LSG and LRYGB. Secondary endpoints are resolution of obesity related comorbidity, complications, revision bariatric surgery and quality of life (QOL) defined in various questionnaires. Discussion: Long-term %EBMIL between the two treatment strategies used to be in favour of LRYGB, but more recent results throughout the world show similar %EBMIL in both techniques. If weight loss is comparable, obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future. Trial registration: Dutch Trial Register: NTR 4741. [ABSTRACT FROM AUTHOR]