Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study.

PURPOSE: Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery. RESULTS: 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. CONCLUSION: We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.

Small bowel obstruction in patients with a prior history of cancer: predictive findings of malignant origins.

BACKGROUND: Determining the cause of acute small bowel obstruction (SBO) in patients previously treated for cancer is necessary for adequate management, especially to avoid incorrectly classing the patient as palliative. We aimed to identify predictive factors for a malignant or a benign origin of SBO. METHODS: We retrospectively studied data for all patients with a prior history of cancer who had undergone operations for SBO between January 2002 and December 2011. Of the 124 patients included, 36 patients had a known cancer recurrence before surgery for SBO, whereas 88 had none. RESULTS: Causes of SBO were benign (post-operative adhesions, post-irradiation strictures) in 68 patients (54.8 %) and malignant in 56 (45.2 %). Incomplete obstruction, acute clinical onset, non-permanent abdominal pain, a shorter period between primary cancer surgery and the first episode of obstruction, and a known cancer recurrence were significant predictors of a malignant SBO. Benign causes of SBO were observed in 72.8 % of patients who had no known cancer recurrence, but were observed in only 11.1 % of patients whose recurrences were known. In patients with cancer recurrence-related SBO, post-operative mortality was 28.6 %, with a median overall survival of 120 days. 1 month after surgery, 38 (67.8 %) of these patients tolerated oral intake. CONCLUSION: A benign cause of SBO was observed in half of the patients with a prior history of cancer and in two-thirds of those without known recurrence. Even in the absence of bowel strangulation, surgery must be considered soon after failure of medical management to treat a possible adhesion-related SBO.

Laparoscopic surgery for colorectal cancer.

Despite the widespread use of laparoscopic techniques in many fields, in the realm of malignant diseases, a great concern has been raised regarding safety, efficacy, and long-term results. The authors report their experience of 163 patients operated on for colorectal malignancies by minimally invasive access. The conversion rate (20.4%), morbidity (15.1%), and null mortality compare well with other studies published worldwide. The postoperative outcome was characterized by a prompt return to activity (1.3 days) and of bowel movements (2.9 days), while length of stay and an adequate oral resumption were comparable to those of open surgery. Peritoneal lavage did not show tumor cells disseminated during the operative maneuvers. The distance of tumor from resection margins and the number of lymph nodes harvested with the operative specimen did not vary from those obtained in open surgery. Two patients (1.2%) recurred at the mini-laparotomy and port sites, but, in both cases, the traumatic manipulation of the cancer specimen was probably responsible for the event. After a mean follow-up of over 3 years, 34 patients died of neoplastic recurrence, and 17 are alive with disease relapse. The laparoscopic approach to colectomy has not yet gained an unquestioned place in the experience of the colorectal surgeon. However, if sound surgical method and judgement are used to minimize local recurrences, and if a better preservation of postoperative immune function proves to be of clinical significance in the long term, laparoscopic colectomy may prove to be a safe and less stressful approach to colon resection.