Introduction/Background To date, thirteen malignancies have been recognized as obesity-related cancers, including breast (in postmenopausal women), endometrial, and ovarian. The aim of this review is to document current evidence on the underlying mechanisms, the clinical data, and the potential applications of metabolic bariatric surgery (MBS) in all types of gynecologic cancer (GC), including breast, endometrial, ovarian, cervical, vulvar, and vaginal.

Methodology A literature search was performed in October 2023 via Pubmed and Google Scholar. Search terms included ‘gynecologic*/breast/endometri*/uter*/ovar*/cervi*/vuvla*/vaginal’ AND ‘cancer/malignancy/neoplas*’ AND ‘obesity/adiposity’ AND ‘bariatric surgery/metabolic surgery/sleeve gastrectomy/bypass’. Only publications in English were included. Case reports were excluded. Particular attention was given to articles presenting pathophysiologic mechanisms, population-based studies, systematic reviews, and meta-analyses, especially those that were published in or after 2019 or to the most recent evidence available.

Results Linking mechanisms between obesity and GC include insulin resistance, adipokine imbalance, increased peripheral aromatization and estrogens, tissue hypoxia, and disrupted immunity in the cellular milieu. Beyond the connection at a molecular and cellular level, clinicians should always keep in mind that obesity might have secondary impacts on the diagnosis and treatment of GC, including limited access to effective screening programs, resistance to chemotherapy and targeted therapies, persisting lymphedema, etc. MBS represents an attractive intervention not only for decreasing the risk of carcinogenesis in high-risk women living with obesity but most importantly as a measure to improve disease-specific and overall survival in patients with diagnosed obesity-related GC. However, well-documented benefits arise only for breast cancer in postmenopausal women, endometrial cancer in premenopausal women, and ovarian cancer.

Conclusion Obesity is not merely a risk factor for gynecologic carcinogenesis, but an inherently connected process. In this regard, metabolic bariatric surgery could serve both as a safe and effective means of primary prevention in high-risk patients and as a secondary prevention measure in GC survivors.

Disclosures N/A.