Stefano Uccella1, Matteo Bonzini2, Stefano Palomba3, Francesco Fanfani4, Marcello Ceccaroni5, Renato Seracchioli6, Enrico Vizza7, Annamaria Ferrero8, Giovanni Roviglione5, Paolo Casadio6, Giacomo Corrado7, Giovanni Scambia4, Fabio Ghezzi9. 1. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it. 2. Epidemiology and Preventive Medicine Research Center, Insubria University, Varese, Italy. 3. Unit of Obstetrics and Gynecology, IRCCS-ASMN of Reggio Emilia, Italy. 4. Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy. 5. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy. 6. Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 7. Department of Oncological Surgery, Gynecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy. 8. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy. 9. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Abstract
OBJECTIVE: To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. DESIGN: Retrospective case-control study (Canadian Task Force classification II-1). SETTING: Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. PATIENTS: Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. INTERVENTIONS: Laparoscopic or open surgical treatment for endometrial cancer. MEASUREMENTS AND MAIN RESULTS: A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI <40, but increased in those with BMI ≥40 (8.6%; p = .05). PS analysis showed a lower complication rate, shorter hospital stay, and greater likelihood of receiving lymphadenectomy in obese women in the laparoscopic group. CONCLUSION: Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese patients can be challenging regardless of the surgical approach taken, especially in cases of morbid adiposity.
OBJECTIVE: To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. DESIGN: Retrospective case-control study (Canadian Task Force classification II-1). SETTING: Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. PATIENTS: Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. INTERVENTIONS: Laparoscopic or open surgical treatment for endometrial cancer. MEASUREMENTS AND MAIN RESULTS: A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obesewomen compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI <40, but increased in those with BMI ≥40 (8.6%; p = .05). PS analysis showed a lower complication rate, shorter hospital stay, and greater likelihood of receiving lymphadenectomy in obesewomen in the laparoscopic group. CONCLUSION: Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obesepatients. However, operating on obesepatients can be challenging regardless of the surgical approach taken, especially in cases of morbid adiposity.
Authors: Nicole Concin; Carien L Creutzberg; Ignace Vergote; David Cibula; Mansoor Raza Mirza; Simone Marnitz; Jonathan A Ledermann; Tjalling Bosse; Cyrus Chargari; Anna Fagotti; Christina Fotopoulou; Antonio González-Martín; Sigurd F Lax; Domenica Lorusso; Christian Marth; Philippe Morice; Remi A Nout; Dearbhaile E O'Donnell; Denis Querleu; Maria Rosaria Raspollini; Jalid Sehouli; Alina E Sturdza; Alexandra Taylor; Anneke M Westermann; Pauline Wimberger; Nicoletta Colombo; François Planchamp; Xavier Matias-Guiu Journal: Virchows Arch Date: 2021-02 Impact factor: 4.064
Authors: Z M Gambacorti-Passerini; C López-De la Manzanara Cano; C Pérez Parra; M C Cespedes Casas; L Sánchez Hipólito; C Martín Francisco; J R Muñoz-Rodríguez Journal: Obes Surg Date: 2019-10 Impact factor: 4.129
Authors: Katherine A O'Hanlan; Pamela L Emeney; Madelyn I Frank; Leila C Milanfar; Margaret S Sten; Kathryn F Uthman Journal: JSLS Date: 2021 Apr-Jun Impact factor: 2.172