Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study.

BACKGROUND: Exocrine pancreatic insufficiency (EPI) can be seen after bariatric/metabolic surgery. Fecal elastase level is a simple test in diagnosing and grading EPI. Quality of life changes in patients with bariatric/metabolic surgery related to gastrointestinal complaints is debated. AIM: This study aimed to investigate rates and grades of EPI via fecal elastase levels and association between EPI and quality of life in bariatric surgery patients. METHODS: A prospective study was performed for patients with bariatric/metabolic surgery at their second-year follow-up. Fecal elastase levels were used to diagnose and grade EPI as severe or moderate. Patient's gastrointestinal quality of life index (GIQLI) was calculated. Patients were grouped as sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), single-anastomosis sleeve ileal bypass (SASI), and transit bipartition (TB). Rates of severe or moderate EPI were primary outcome. Secondary outcome was an association between fecal elastase and GIQLI. RESULTS: There were 17, 29, 21, and 15 patients in OAGB, SG, TB, and SASI groups. There was no significant difference between groups in GIQLI scores and fecal elastase levels (p = 0.152 and p = 0.361). Rates of patients with moderate EPI in the groups OAGB, SG, TB, and SASI were 23.5%, 17.2%, 14.3%, and 20.0%. GIQLI scores were not significantly correlated with age, postoperative morphometric data, and fecal elastase values (p > 0.05). CONCLUSION: Rates of patients with moderate EPI ranged from 14.3 to 23.5% at second-year follow-up. There was no patient with severe EPI. GIQLI scores were not significantly correlated with fecal elastase levels and different types of bariatric/metabolic surgery.

Long-term results and prognostic factors after surgical treatment for gallbladder cancer.

Objectives: Gallbladder cancer is relatively rare and traditionally regarded as having poor prognosis. There is controversy about the effects of clinicopathological features and different surgical techniques on prognosis. The aim of this study was to investigate the effects of clinicopathological characteristics of the patients with surgically treated gallbladder cancer on long-term survival. Material and Methods: We retrospectively analyzed the database of gallbladder cancer patients treated at our clinic between January 2003 and March 2021. Results: Of 101 evaluated cases, 37 were inoperable. Twelve patients were determined unresectable based on surgical findings. Resection with curative intent was performed in 52 patients. The one-, three-, five-, and 10-year survival rates were 68.9%, 51.9%, 43.6%, and 43.6%, respectively. Median survival was 36.6 months. On univariate analysis, poor prognostic factors were determined as advanced age; high carbohydrate antigen 19-9 and carcinoembryonic antigen levels; non-incidental diagnosis; intraoperative incidental diagnosis; jaundice; adjacent organ/structure resection; grade 3 tumors; lymphovascular invasion; and high T, N1 or N2, M1, and high AJCC stages. Sex, IVb/V segmentectomy instead of wedge resection, perineural invasion, tumor location, number of resected lymph nodes, and extended lymphadenectomy did not significantly affect overall survival. On multivariate analysis, only high AJCC stages, grade 3 tumors, high carcinoembryonic antigen levels, and advanced age were independent predictors of poor prognosis. Conclusion: Treatment planning and clinical decision-making for gallbladder cancer requires individualized prognostic assessment along with standard anatomical staging and other confirmed prognostic factors.