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