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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Open Access Indonesian Journal of Medical Reviews Bioscientia Medicina : Journal of Biomedicine and Translational Research
Stephen William Soeseno
General Surgery Resident, Department of Surgery, Prof. Dr. I.G.N.G. Ngoerah General Hospital/Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Efficacy of Multimodal Prehabilitation vs. Standard Care on Postoperative Morbidity and Quality of Life in Major Gastrointestinal Oncology Surgery: A Systematic Review and Meta-Analysis Stephen William Soeseno; Made Agus Dwianthara Sueta
Open Access Indonesian Journal of Medical Reviews Vol. 6 No. 1 (2026): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v6i1.864

Abstract

Major gastrointestinal oncology surgery induces profound physiological stress, precipitating a severe reduction in functional capacity and high rates of postoperative complications. Traditional perioperative pathways optimize intraoperative and postoperative care but systematically overlook preoperative functional reserves. A systematic review and meta-analysis were conducted in strict adherence to PRISMA guidelines. Systematic searches were executed across PubMed, Embase, Cochrane CENTRAL, and Scopus from database inception to March 2026. High-quality clinical trials evaluating multimodal prehabilitation against standard care in gastrointestinal cancer surgery were analyzed. Pooled odds ratios (OR) and standardized mean differences (SMD) with 95% Confidence Intervals (CI) were calculated using a random-effects model, with heterogeneity assessed via the $I^2$ statistic. Multimodal prehabilitation significantly reduced overall 30-day postoperative complications compared to standard care (OR 0.35, 95% CI: 0.18–0.69, p=0.010, $I^2$=42%). This was driven primarily by a striking decrease in Grade II pulmonary infections. Functional capacity was remarkably preserved; prehabilitated patients demonstrated statistically superior walking distances postoperatively (SMD 1.25, 95% CI: 0.95–1.55, p<0.001). Sarcopenic patients receiving targeted nutritional supplementation with beta-hydroxy beta-methylbutyrate exhibited sustained improvements in chair rise repetitions (Mean Difference 4.0, 95% CI: 2.5–5.5) and significant physiological remodeling of intramuscular adipose tissue. In conclusion, multimodal prehabilitation fundamentally alters the physiological trajectory of patients undergoing major gastrointestinal oncology surgery. By proactively mitigating surgical stress and attenuating catabolic decline, this intervention ensures superior functional restitution and minimizes short-term morbidity.
Menopausal Status as the Strongest Independent Predictor of Neoadjuvant Chemotherapy Response in Locally Advanced Breast Cancer Stephen William Soeseno; I Wayan Sudarsa; Ni Gusti Ayu Agung Manik Yuniawaty Wetan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1621

Abstract

Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer (LABC), yet predicting individual patient response remains challenging. This study investigates menopausal status and other clinicopathological factors as predictors of NAC response in a Southeast Asian population. Methods: This retrospective cohort study analyzed 247 LABC patients treated with NAC between 2022–2023 at the Oncology Surgery Division, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali. Variables included menopausal status (premenopausal vs. postmenopausal), histological type, histological grading, molecular subtype, lymphovascular invasion (LVI), tumor-infiltrating lymphocytes (TIL), and age. Bivariate analysis used chi-square tests; multivariate logistic regression identified independent predictors. Results: Among 247 patients (mean age 51.7 ± 9.1 years), 130 (52.6%) achieved positive response. Postmenopausal patients demonstrated significantly higher response rates (79.7% vs. 12.1%, p<0.001). Multivariate analysis revealed menopausal status as the strongest predictor (OR=14.999, 95%CI: 6.045–37.213, p<0.001), followed by molecular subtype (OR=4.182, p=0.006), histological grading (OR=3.596, p=0.010), and histological type (OR=0.367, p=0.017). Age, LVI, and TIL lost statistical significance in the multivariate model. Conclusion: Menopausal status emerged as the strongest independent predictor of NAC response in LABC, suggesting that hormonal factors play a pivotal role in chemotherapy sensitivity. These findings support more aggressive NAC regimens or combined endocrine-cytotoxic strategies for postmenopausal patients and warrant validation in prospective Southeast Asian cohorts.
Menopausal Status as the Strongest Independent Predictor of Neoadjuvant Chemotherapy Response in Locally Advanced Breast Cancer Stephen William Soeseno; I Wayan Sudarsa; Ni Gusti Ayu Agung Manik Yuniawaty Wetan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1621

Abstract

Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer (LABC), yet predicting individual patient response remains challenging. This study investigates menopausal status and other clinicopathological factors as predictors of NAC response in a Southeast Asian population. Methods: This retrospective cohort study analyzed 247 LABC patients treated with NAC between 2022–2023 at the Oncology Surgery Division, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali. Variables included menopausal status (premenopausal vs. postmenopausal), histological type, histological grading, molecular subtype, lymphovascular invasion (LVI), tumor-infiltrating lymphocytes (TIL), and age. Bivariate analysis used chi-square tests; multivariate logistic regression identified independent predictors. Results: Among 247 patients (mean age 51.7 ± 9.1 years), 130 (52.6%) achieved positive response. Postmenopausal patients demonstrated significantly higher response rates (79.7% vs. 12.1%, p<0.001). Multivariate analysis revealed menopausal status as the strongest predictor (OR=14.999, 95%CI: 6.045–37.213, p<0.001), followed by molecular subtype (OR=4.182, p=0.006), histological grading (OR=3.596, p=0.010), and histological type (OR=0.367, p=0.017). Age, LVI, and TIL lost statistical significance in the multivariate model. Conclusion: Menopausal status emerged as the strongest independent predictor of NAC response in LABC, suggesting that hormonal factors play a pivotal role in chemotherapy sensitivity. These findings support more aggressive NAC regimens or combined endocrine-cytotoxic strategies for postmenopausal patients and warrant validation in prospective Southeast Asian cohorts.
Menopausal Status as the Strongest Independent Predictor of Neoadjuvant Chemotherapy Response in Locally Advanced Breast Cancer Stephen William Soeseno; I Wayan Sudarsa; Ni Gusti Ayu Agung Manik Yuniawaty Wetan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1621

Abstract

Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer (LABC), yet predicting individual patient response remains challenging. This study investigates menopausal status and other clinicopathological factors as predictors of NAC response in a Southeast Asian population. Methods: This retrospective cohort study analyzed 247 LABC patients treated with NAC between 2022–2023 at the Oncology Surgery Division, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali. Variables included menopausal status (premenopausal vs. postmenopausal), histological type, histological grading, molecular subtype, lymphovascular invasion (LVI), tumor-infiltrating lymphocytes (TIL), and age. Bivariate analysis used chi-square tests; multivariate logistic regression identified independent predictors. Results: Among 247 patients (mean age 51.7 ± 9.1 years), 130 (52.6%) achieved positive response. Postmenopausal patients demonstrated significantly higher response rates (79.7% vs. 12.1%, p<0.001). Multivariate analysis revealed menopausal status as the strongest predictor (OR=14.999, 95%CI: 6.045–37.213, p<0.001), followed by molecular subtype (OR=4.182, p=0.006), histological grading (OR=3.596, p=0.010), and histological type (OR=0.367, p=0.017). Age, LVI, and TIL lost statistical significance in the multivariate model. Conclusion: Menopausal status emerged as the strongest independent predictor of NAC response in LABC, suggesting that hormonal factors play a pivotal role in chemotherapy sensitivity. These findings support more aggressive NAC regimens or combined endocrine-cytotoxic strategies for postmenopausal patients and warrant validation in prospective Southeast Asian cohorts.
Menopausal Status as the Strongest Independent Predictor of Neoadjuvant Chemotherapy Response in Locally Advanced Breast Cancer Stephen William Soeseno; I Wayan Sudarsa; Ni Gusti Ayu Agung Manik Yuniawaty Wetan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1621

Abstract

Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer (LABC), yet predicting individual patient response remains challenging. This study investigates menopausal status and other clinicopathological factors as predictors of NAC response in a Southeast Asian population. Methods: This retrospective cohort study analyzed 247 LABC patients treated with NAC between 2022–2023 at the Oncology Surgery Division, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali. Variables included menopausal status (premenopausal vs. postmenopausal), histological type, histological grading, molecular subtype, lymphovascular invasion (LVI), tumor-infiltrating lymphocytes (TIL), and age. Bivariate analysis used chi-square tests; multivariate logistic regression identified independent predictors. Results: Among 247 patients (mean age 51.7 ± 9.1 years), 130 (52.6%) achieved positive response. Postmenopausal patients demonstrated significantly higher response rates (79.7% vs. 12.1%, p<0.001). Multivariate analysis revealed menopausal status as the strongest predictor (OR=14.999, 95%CI: 6.045–37.213, p<0.001), followed by molecular subtype (OR=4.182, p=0.006), histological grading (OR=3.596, p=0.010), and histological type (OR=0.367, p=0.017). Age, LVI, and TIL lost statistical significance in the multivariate model. Conclusion: Menopausal status emerged as the strongest independent predictor of NAC response in LABC, suggesting that hormonal factors play a pivotal role in chemotherapy sensitivity. These findings support more aggressive NAC regimens or combined endocrine-cytotoxic strategies for postmenopausal patients and warrant validation in prospective Southeast Asian cohorts.
Co-Authors I Wayan Sudarsa Made Agus Dwianthara Sueta Ni Gusti Ayu Agung Manik Yuniawaty Wetan