Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial).

PURPOSE: Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. OBJECTIVES: This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. METHODS: Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. RESULTS: The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m2; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m2; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 × -0.5%; p<0.01) as well as LDL control (-27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. CONCLUSION: Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.

Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial).

BACKGROUND: The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. OBJECTIVES: The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. SETTING: University hospital, São Paulo, Brazil. METHODS: We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged ≥65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. RESULTS: A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m2 were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P = .13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P = .07). Each group had 1 readmission and there was no mortality in 90-day follow-up. CONCLUSIONS: Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGB in this population setting.

The geriatrician's perspective on practical aspects of the multidisciplinary care of older adults with cancer.

Multidisciplinary teams (MDTs) have been incorporated into the practical care of elderly patients with cancer. Several geriatric oncology centres have attempted to determine the best way to implement MDTs by using geriatric assessment (GA). Developing a geriatric oncology service is a feasible work, which requires significant resources. The challenges of MDTs must be known so that better care planning for elderly patients with cancer can be devised. The aim of this paper is to discuss the practical aspects of the multidisciplinary care of older adults with cancer by considering a geriatric point of view and the recent literature. Reviewing data from recent studies helps enumerate the major challenges in establishing collaboration in geriatric oncology: evaluating the resources of your centre, knowing the role of each member of the team, establishing good communication both within the team and with the patients, and determining referral criteria and using screening tests to select which patients can benefit the most from the multidisciplinary evaluation and a more thorough GA.