PURPOSE OF REVIEW: Bariatric surgery is the most effective intervention for severe obesity, yet challenges such as perioperative risks in super-obesity and long-term weight regain persist. This narrative review proposes a novel multimodal framework for integrating GLP-1 receptor agonists (GLP-1 RAs) into surgical pathways. Drawing a conceptual analogy from oncologic "neoadjuvant" and "adjuvant" treatment models, we explore how pharmacotherapy can optimize surgical safety and reinforce long-term metabolic control.
RECENT FINDINGS: Emerging clinical data from prospective trials demonstrate that a short-term "neoadjuvant" course of GLP-1 receptor agonists can significantly enhance early weight loss and dyslipidemia remission without compromising perioperative safety. Conversely, retrospective analyses suggest that while preoperative weight loss is achievable, it requires careful management to mitigate potential early metabolic adaptation and prevent the "ceiling effect" on postoperative outcomes. Regarding postoperative care, recent meta-analyses confirm that adjuvant pharmacotherapy effectively addresses weight regain and sustains metabolic improvements in suboptimal responders, supporting the implementation of a structured perioperative management ladder. Obesity management is shifting from a procedure-centric approach toward a chronic, multimodal disease model. The neoadjuvant/adjuvant paradigm encourages clinicians to leverage pharmacologic tools to enhance surgical efficacy ("downstaging" risk) and prevent disease recurrence. While primarily hypothesis-generating, this framework provides a structured foundation-including a proposed perioperative management ladder-for future randomized controlled trials to establish integrated, multidisciplinary clinical standards.
