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Rossoni C, Bragança R, Santos Z, Viveiros O, Ribeiro R. OAGB Bowel Function in Patients With up to 5 Years Follow-Up: Updated Outcomes. Obes Surg 2024; 34:141-149. [PMID: 37946012 PMCID: PMC10781852 DOI: 10.1007/s11695-023-06917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE One-anastomosis gastric bypass (OAGB) is considered an effective technique in weight reduction and remission of comorbidities. However, in common with many bariatric and metabolic/bariatric procedures, gastrointestinal side effects are frequently reported, but clinical experience varies. The objective of this study was to analyze the bowel function of patients who undergo OAGB looking at 5-year postoperative outcomes. METHOD This study is cross-sectional, descriptive and analytical, developed with individuals undergoing OAGB (n = 208) in yhe period between 2015 and 2020. The time periods evaluated were 1 to 6 months (T1), 6 to 12 months (T2), and 1 to 5 years (T3). Data analysis was performed using SPSS v.28.0, considering a significance level p ≤ 0.05. RESULTS 114 participants (54.8%), 79.8% women, mean age 47.0 ± 12.6 years, and BMI 40.1 ± 5.6 kg/m2, 51.9% dyslipidemia, 43.6% arterial hypertension, and 19.1% diabetes mellitus. The T1 group had more severe symptoms/nausea than the T2 group. The T2 group had a significantly lower defecation frequency than the T1 and T3 groups. As for the occurrence of diarrhea, associations were not found in the considered groups. The T3 group had a greater severity of constipation associated with greater difficulty in consuming red meat, white meat, rice, vegetables, and salads. CONCLUSIONS Gastrointestinal symptoms are prevalent in the first postoperative months. However, diarrhea was not common. The patient selection policy and surgical technique were decisive in this result. Constipation was prevalent in patients between 1 and 5 postoperative years. It was also prevalent in those who had food intolerance, which from a nutritional point of view is an adverse factor for optimal bowel function.
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Affiliation(s)
- Carina Rossoni
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal.
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026, Lisbon, Portugal.
- School of Sciences and Health Technologies, Nutrition Sciences, Universidade Lusófona de Humanidades e Tecnologias, 1749-024, Lisbon, Portugal.
| | - Rossela Bragança
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- Nutrition Service of the Centro Hospitalar Univesitário Lisboa Central, 1150-199, Lisbon, Portugal
| | - Zélia Santos
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal
| | - Octávio Viveiros
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- General Surgery Department at Hospital Lusíadas Amadora, 2724-022, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas Lisboa, 1500-458, Lisbon, Portugal
| | - Rui Ribeiro
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- General Surgery Department at Hospital Lusíadas Amadora, 2724-022, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas Lisboa, 1500-458, Lisbon, Portugal
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de Pinho IS, Luz P, Alves L, Lopes-Brás R, Patel V, Esperança-Martins M, Gonçalves L, Freitas R, Simão D, Galnares MR, Fernandes I, Criado SA, Casado SG, Cañada JB, Vega IMS, Costa JG, Fernandes AS, de Sousa RT, Costa L. Anthracyclines versus No Anthracyclines in the Neoadjuvant Strategy for HER2+ Breast Cancer: Real-World Evidence. Clin Drug Investig 2023; 43:691-698. [PMID: 37479867 PMCID: PMC10514156 DOI: 10.1007/s40261-023-01291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Deescalation strategies omitting anthracyclines (AC) have been explored in early human epidermal growth factor receptor 2-positive breast cancer (HER2+ EBC), showing similar efficacy regarding pathological complete response (pCR) and long-term outcomes as AC-containing regimens. The standard treatment for this tumor subtype is based on chemotherapy and dual HER2 blockade with trastuzumab and pertuzumab, with AC-containing regimens remaining a frequent option for these patients, even in non-high-risk cases. The primary aim of this study was to assess and compare the effectiveness of neoadjuvant regimens with and without AC used in the treatment of HER2+ EBC in the clinical practice according to the pCR achieved with each. METHODS This retrospective multicentric study included patients with HER2+ EBC from Portuguese, Spanish, and Chilean hospitals (January 2018-December 2021). Patients receiving neoadjuvant therapy (NAT) with dual HER2 blockade (trastuzumab and pertuzumab), followed by surgery, were included. Statistical analysis used chi-squared/Fisher's exact test for associations, multivariate logistic regression for pCR, and Kaplan-Meier method for event-free survival (EFS). IBM SPSS Statistics 29.0 analyzed the data. RESULTS The study included 371 patients from eight hospitals. Among them, 237 received sequential AC and taxane-based chemotherapy with 4 cycles of trastuzumab and pertuzumab, while 134 received 6 cycles of TCHP (docetaxel, carboplatinum, trastuzumab, and pertuzumab). The average age of the patients was 52.8 years and 52.7 years, respectively. Omitting AC from the neoadjuvant approach did not preclude achieving pCR [p = 0.246, 95% confidence interval (CI) 0.235-0.257] and was safe regardless of patient characteristics. Relapse rates were 6.8% (16 patients) in the AC group and 4.5% (6 patients) in the TCHP group. Over a median follow-up of 2.9 years, the estimated 3-year EFS was 92.5% in the AC group and 95.4% in the TCHP group (hazard ratio 0.602, 95% CI 0.234-1.547, p = 0.292, favoring TCHP). CONCLUSION This study reports real-world evidence showing similar pCR and EFS outcomes with treatment regimens with and without AC and raises awareness of possible overtreatment and long-term toxicity in some patients with HER2+ EBC with the use of AC.
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Affiliation(s)
| | - Paulo Luz
- Medical Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal.
- Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.
| | - Lucy Alves
- Medical Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Raquel Lopes-Brás
- Medical Oncology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Vanessa Patel
- Medical Oncology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | | | - Lisa Gonçalves
- Medical Oncology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Ritas Freitas
- Medical Oncology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Diana Simão
- Medical Oncology Department, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | | | - Isabel Fernandes
- Medical Oncology Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | | | | | - Jose Baena Cañada
- Medical Oncology Department, Hospital Universitário Puerta del Mar, Cádiz, Spain
| | - Isabel M Saffie Vega
- Unidad de Cirugía Oncológica y Reconstructiva Mamaria, Fundación Arturo López Pérez, Chile
| | - João G Costa
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Ana S Fernandes
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | | | - Luís Costa
- Medical Oncology Department, Hospital de Santa Maria, CHULN, Lisbon, Portugal
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