The number of obese people is over one billion worldwide, and the trend is increasing. Frequent failure of conservative approach has been observed. Therefore, various surgical techniques, such as bariatric surgery, are accepted today as a safe and effective treatment of morbid obese condition, and are associated with low perioperative morbidity and mortality rates. The most popular and commonly performed procedures are those related to minimum complications and adequate weight loss: laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Since major and minor complications occur in the perioperative, early and late postoperative period, we discuss most frequent complications and importance of early recognition as well as adequate interventions.
introduction: after the consensus conference in st. gallen and updated nccn guidelines, we started doing sentinel lymph node biopsy (slnB) in May 2017, for breast cancer patients who achieve clinical axillary remission following neoadjuvant treatment. this study's primary goal was to evaluate the clinical impact of slnB after neoadjuvant therapy in the group mentioned above. Methods: We retrospectively analyzed all neoadjuvant breast cancer patients from May 2016 until May 2018 at clinical Hospital center rijeka. our preliminary results recorded the appearance of locoregional and distant recurrence. results: from 65 patients involved in this analysis, 48 patients were node-positive at the time of diagnosis, and 45.83% among those achieved complete pathological axillary remission. After the first postoperative year, there were no locoregional relapses nor statistically significant differences in the prevalence of distant recurrences, regardless of the extent of surgical procedure. However, results showed higher rates of locoregional and distant relapse for the group of patients that did not attain complete axillary remission. conclusion: slnB is a reliable alternative to alnD for locoregional and overall disease control for breast cancer patients who achieve complete clinical axillary remission after preoperative systemic treatment. the clinical axillary lymph node status, after neoadjuvant therapy, is a more relevant prognostic factor than the clinical axillary lymph node status at the beginning of the treatment.
Background: Upon St. Gallen consensus conference (1) and updated version of NCCN guidelines (2) from 2017, in May 2017 in Clinical Hospital Center Rijeka sentinel lymph node biopsy (SLNB) was introduced in clinical practice for axillary staging of breast cancer patients that achieved complete clinical axillary remission after neoadjuvant systemic oncologic treatment. This trial aims to evaluate the clinical impact of SLNB performance after neoadjuvant systemic treatment (NAST) in initially node-positive breast cancer patients and to determine the prognostic value of the axillary complete pathological response. Patients and Methods: Breast cancer patients in clinical stage T1-T3 N0-N2 M0, surgically treated in our institution from September 2018 till May 2022 would be included in this trial and divided into three groups according to protocol. SLNB would be performed in all patients presenting with cN0 stage at the time of surgery, including those patients who shift from cN1-N2 to cN0 during NAST. All patients involved in this trial would be monitored for five postoperative years in order to determine following parameters: rates of local and regional recurrence, rate of disease progression to M1 stage, regional recurrence-free survival, disease progression-free survival, cancer-related mortality rate, and overall survival. Results: Results gained from this trial would be compared among groups and with our previous data of patients in equivalent stage treated in period from 2011 till 2014 when all patients were primary surgically treated, therefore axillary lymph node dissection (ALND) was performed for all node-positive patients. Conclusion: Hopefully, the results of this trial would provide enough evidence that SLNB performance after NAST does not have a negative impact on clinical outcome in breast cancer patients who had reached complete clinical axillary remission. In addition, we would try to determine the prognostic value of the axillary complete pathologic response. ClinicalTrials.gov: This protocol has been registered at clinicaltrials.
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