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Adherence to ESGO guidelines and impact on survival in obese patients with endometrial cancer: a multicentric retrospective study
  1. Samia Ouasti1,
  2. Johanna Ilic1,
  3. Camille Mimoun2,
  4. Sofiane Bendifallah1,
  5. Cyrille Huchon2,
  6. Lobna Ouldamer3,
  7. Jerome Lorenzini3,
  8. Vincent Lavoué4,
  9. Emilie Raimond5,
  10. Ludivine Dion6,
  11. Hélène Costaz7,
  12. Pierre-Francois Dupre8,
  13. Olivier Graesslin9,
  14. Jennifer Uzan10,
  15. Yohan Kerbage11,
  16. Pauline Chauvet12,
  17. Geoffroy Canlorbe13,
  18. Cyril Touboul1 and
  19. Yohann Dabi1
  1. 1 Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
  2. 2 Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
  3. 3 Department of Gynaecology, Hôpital Bretonneau, Tours, France
  4. 4 Department og Gynecology and Obstetrics, Rennes 1 University, Rennes, France
  5. 5 Department of Gyneacology and Obstetrics, Reims Champagne-Ardenne University, Reims, France
  6. 6 Department of Gynecology and Obstetrics, Rennes 1 University, Rennes, France
  7. 7 Departement of Oncology Surgery, Georges-François Leclerc Centre, Dijon, France
  8. 8 Department of Gynaecology, CHU Brest, Brest, France
  9. 9 Department of Obstetrics and Gynecology, Université de Reims Champagne-Ardenne, Reims, France
  10. 10 Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil (CHI Créteil), Créteil, France
  11. 11 Hopital Jeanne de Flandre, Lille, France
  12. 12 Department of Gynaecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
  13. 13 Department of Gynecological and Breast Surgery and Oncology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
  1. Correspondence to Dr Yohann Dabi, Department of Obstetrics, Tenon Hospital Department of Obstetrics Gynaecology and Reproductive Medicine, Paris, 75020, France; yohann.dabi{at}


Objectives Obesity is known to be both a major risk factor for endometrial cancer and associated with surgical complexity. Therefore, the management of patients with obesity is a challenge for surgeons and oncologists. The aim of this study is to assess the adherence to European Society of Gynaecological Oncology (ESGO) guidelines in morbidly obese patients (body mass index (BMI) >40 kg/m2). The secondary objectives were the impact on overall survival and recurrence-free survival.

Methods All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30–40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies.

Results In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04).

Conclusion Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.

  • Sentinel Lymph Node
  • Endometrial Neoplasms
  • Obesity, Morbid
  • Surgical Oncology

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.