Elsevier

Gynecologic Oncology

Volume 139, Issue 2, November 2015, Pages 369-376
Gynecologic Oncology

Review
The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—An institutional study and systematic review of the literature

https://doi.org/10.1016/j.ygyno.2015.09.020Get rights and content

Highlights

  • Obesity increases risk of postoperative complications in endometrial cancer.

  • Laparoscopic surgery reduces postoperative complications in obese women.

  • Prehabilitation may be a means to further reduce surgical morbidity.

Abstract

Objectives

We aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature.

Methods

This was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI < 30 kg/m2, BMI ≥ 30 kg/m2 and BMI ≥ 40 kg/m2. The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Results

In total, we identified 627 women of which 514 were included; 249 women had a BMI of < 30 kg/m2, 195 women had a BMI of 30–39.9 kg/m2, and 70 women were morbidly obese (BMI ≥ 40 kg/m2). Obese women (BMI ≥ 30 kg/m2) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality.

Conclusion

Obesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.

Section snippets

Background

Endometrial cancer (EC) is the most common gynaecological malignancy in the UK, with over 8000 women being diagnosed annually [1]. The incidence has risen over the recent decades, most likely due to increasing obesity [2], [3], with studies reporting up to 81% of EC patients being obese, and 19% to 36% being morbidly obese [4], [5]. Furthermore, the majority of these women are insufficiently active and have several medical obesity-related comorbidities [6], [7]. This poses significant

Design and setting

We performed a retrospective cohort study of surgically managed EC patients at the Royal Cornwall Hospital Trust (RCHT). The study population consisted of women who underwent surgery for EC between January 2006 and January 2015. During this period, surgical management shifted from open approach to laparoscopic approach. We excluded women with insufficient data on their perioperative course, or an unknown preoperative BMI. Ethical approval was obtained through the London–Fulham Ethical committee

Primary study

A total of 627 EC patients were identified, of which 548 patients had undergone surgical management. Excluded were 17 women who received treatment elsewhere, eight women with incomplete data on their perioperative course, six women with leiomyosarcoma, and a further three women with an unknown BMI preoperatively. Consequently, our study population consisted of 514 patients (Fig. 1).

Characteristics of the study population are summarised in Table 1. The median age was 66 years with a range of 27–93

Discussion

Endometrial cancer is strongly associated with obesity, resulting in the majority of patients being obese [27]. The aim of this study was to give a comprehensive overview of the current literature on the impact of BMI on the surgical complications and outcomes of EC patients, and to provide guidance for clinical care and future studies.

The institutional study showed that obesity is a risk factor for overall and postoperative surgical complications, including wound complications and increased

Conclusion

The results of our institutional study and systematic review confirm that obesity is associated with an increased risk of surgical morbidity in EC patients. This association is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may prevent the majority of postoperative complications in this group of patients, and should therefore be advocated for obese women. In addition, we propose the evaluation of prehabilitation programmes as a means to minimise surgical

Conflict of interest statement

  • i)

    We declare that the contents of this paper have not been published or considered for publication elsewhere.

  • ii)

    All authors made substantial contribution to conception and design, and/or acquisition of data and/or analysis and interpretation of data; participated in drafting the article or revising it critically for important intellectual content; and gave final approval of the version to be submitted and any revised version to be published.

  • iii)

    There is no financial support or relationship that may pose

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