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1. Long-term weight loss and metabolic benefit from Roux-en-Y gastric bypass in patients with superobesity

Author

Mantziari, S., Thomopoulos, T., Abboretti, F., Gaspar-Figueiredo, S., Dayer, A., Demartines, N., and Suter, M.

Subjects
Adult, Male, Weight Loss, Gastric Bypass, Humans, Female, Retrospective Studies, Obesity, Morbid/surgery, Body Mass Index, Obesity, Morbid
Abstract

Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.

Published
2022

2. 43: NEOADJUVANT CHEMOTHERAPY OFFERS NO SURVIVAL BENEFIT FOR CT2N0M0 GASTRIC ADENOCARCINOMA. A MULTICENTRIC EUROPEAN STUDY.

Author

Abboretti, F, Lambert, C, Schäfer, M, Roy, B Le, Mège, D, Demartines, N, Pezet, D, Gronnier, C, and Mantziari, S

Subjects
*NEOADJUVANT chemotherapy, *GASTRIC bypass, *ADJUVANT chemotherapy, *ESOPHAGEAL tumors, *PROGRESSION-free survival, *ADENOCARCINOMA
Abstract

Background and aim According to current international guidelines, the optimal treatment of stage cT2N0M0 gastric adenocarcinoma consists of preoperative chemotherapy followed by surgery. Surgery first may be suggested in selected patients, especially if considered unfit for chemotherapy. The aim of the present study was to assess if cT2N0M0 patients treated with surgery first (S) had inferior overall and disease-free survival compared to those treated with neoadjuvant chemotherapy followed by surgery (CS). Methods A retrospective analysis was performed among 32 centers, including all consecutive patients with gastric adenocarcinoma operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into two groups, surgery first (S) and neoadjuvant chemotherapy followed by surgery (CS). Clinico-pathological details, overall and disease-free survival were compared between the groups. Cox regression analysis was performed for long-term survival. Results Among the 2131 included patients, 202 (9.5%) had cT2N0M0 disease: 68 (33.7%) were placed in the CS group and 134 (66.3%) in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs 69.8 ± 12.1 years, P  < 0.001) with WHO status 0 in 60.3% versus 34.5% in S patients (P  = 0.006). The CS group had more proximal tumors, undergoing more frequently total gastrectomy (70.6% CS vs 45.5% S, P  = 0.001). The median number of resected lymph nodes was similar (22 vs 20.5, P  = 0.74). R0 resection margins were obtained in 97.1% CS vs 95.5% S patients (P  = 0.72). Adjuvant chemotherapy was more often administered in CS patients (75.8% versus 29.8% in S, P  < 0.001). Recurrence occured in 30.9% in CS and 18.1% in S (P  = 0.04), predominantly as distant metastases (81% CS vs 75% S, P  = 0.76). Overall 5-year survival was similar between CS (74.4%, 95%CI 58.1–85.1) and S groups (66.7%, 95%CI 54.4–76.5, P = 0.73), as was 5-year disease-free survival (DFS) (64.6%, 95%CI 48.4–76.9 for CS vs 62.8%, 95%CI 50.7–72.6 for S, P  = 0.82). Perioperative chemotherapy was not associated with OS or DFS in multivariate analysis. Conclusion Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with CS compared to S. In accordance with esophageal cT2N0 tumors, surgery first might be a valid treatment option for these patients. [ABSTRACT FROM AUTHOR]

Published
2022
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