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Relative Morbidity and Mortality of Panniculectomy-Combined Surgical Staging in Endometrial Cancer
  1. Amin A. Ramzan, MD*,
  2. Jocelyn Garcia-Sayre, MD*,
  3. Marianne S. Hom, BA*,
  4. Kyle A. Graham, BA*,
  5. Joseph N. Carey, MD,
  6. Laila I. Muderspach, MD* and
  7. Koji Matsuo, MD, PhD*,
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and
  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles; and
  3. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Ave, IRD520, Los Angeles, CA 90033. E-mail:


Objective To examine intraoperative and postoperative complication rates for surgical staging combined with panniculectomy for endometrial cancer.

Methods A prospectively collected institutional surgical database was used to identify patients with endometrial cancer who underwent hysterectomy-based surgical staging between December 2008 and August 2014 (n = 551). The cases were grouped into surgical staging with panniculectomy (panniculectomy group, n = 11 [2.0%]), laparotomy without panniculectomy (laparotomy group, n = 208 [37.7%]), and laparoscopy (minimally invasive surgery group, n = 332 [60.3%]). Major complication and surgical wound complication rates within 30 days from surgery were compared.

Results The panniculectomy group had a significantly higher body mass index compared with other approaches (panniculectomy group, laparotomy group, and minimally invasive surgery group: 60.4, 35.7, and 34.1; P < 0.001) and had a high stage I disease rate (90.9%, 61.5%, and 88.3%; P < 0.001). Mean pannus weight was 5733 g (4.4% of body weight). Intraoperative major complication rates were statistically nonsignificant across the groups (0%, 7.2%, and 4.2%; P = 0.23); however, the panniculectomy group had a significantly higher postoperative major complication rate compared with other approaches (36.4%, 16.3%, and 5.1%; P < 0.001). In multivariate analysis controlling for age, ethnicity, body habitus, medical comorbidities, and tumor factors, panniculectomy remained an independent predictor for increased risk of postoperative major complications (adjusted odds ratio, 4.37; P = 0.043). Surgical mortality rates were similar across the groups (0%, 0.5%, and 0%; P = 0.44). Among superobese patients (n = 50), intraoperative and postoperative complication rates were statistically similar across the 3 groups (all, P > 0.05).

Conclusion Although panniculectomy-combined surgical staging is associated with an increased risk of postoperative complications, the majority recovered uneventfully, making this approach a feasible treatment option, especially for superobese patients with endometrial cancer.

  • Endometrial cancer
  • Panniculectomy
  • Surgical staging
  • Complication

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  • Disclosure: The authors declared that there is no conflict of interest in the study.

  • Part of the study was presented at the SGO Early Career Education Summit in Chicago, IL, on December 12–13, 2014.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (