Virginia Vargiu1, Andrea Rosati2, Vito Andrea Capozzi3, Giulio Sozzi4, Alessandro Gioè2, Roberto Berretta3, Vito Chiantera4, Giovanni Scambia5, Francesco Fanfani6, Francesco Cosentino7. 1. Department of Gynecologic Oncology, Gemelli Molise SpA, Campobasso, Italy. 2. Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 3. Department of Medicine and Surgery, University of Parma, Parma, Italy. 4. Department of Gynecologic Oncology, University of Palermo, Palermo, Italy. 5. Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy. 6. Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: francesco.fanfani@policlinicogemelli.it. 7. Department of Gynecologic Oncology, Gemelli Molise SpA, Campobasso, Italy; Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio" Università degli studi del Molise, Italy.
Abstract
OBJECTIVE: Conflicting data exists on the impact of Body Mass Index (BMI) on sentinel lymph-node (SLN) detection. The primary study endpoint was to investigate the impact of obesity on overall detection rate, bilateral mapping, and mapping failure rate of SLN. In addition, we evaluated possible differences in terms of surgical management and "empty-packet dissection" rate among obese and non-obese patients. METHODS: Multicenter, propensity-matched, retrospective study. Patients with apparent early-stage endometrial cancer were included. Study population was divided into women with BMI </≥ 30 (Group-1 and Group-2). To lower the selection bias, a propensity-matched analysis was performed. Matching was based on histotype (endometrioid vs non-endometrioid), age (</≥65 years old), and presence of lymph-vascular space invasion. RESULTS: Eight-hundred forty-four women were enrolled. After a 1:1 propensity-matched analysis, 764 patients were identified (Group-1 n = 382, Group-2 n = 382). A 1.156-fold increase in the risk of mapping failure for every 5 units of BMI increase was found (OR 1.156, 95% CI 1.033-1.294, p = 0.012), with a consequently decrease in bilateral mapping and overall detection rate (respectively OR 0.865, 95% CI 0.773-0.968, p = 0.012 and OR 0.785, 95% CI 0.670-0.920, p = 0.003). Obese patients were surgically under-staged in 9.4% of cases and showed an 8.2% of empty packet dissection (surgical under-staging: 5.0% vs 9.4%, p = 0.017; empty-packet dissection: 3.9% vs 8.2%, p = 0.022). CONCLUSIONS: BMI was confirmed as a statistically relevant predictor of mapping failure and decreased overall detection rate. In addition, obese women had a significantly higher odds of empty packet dissection.
OBJECTIVE: Conflicting data exists on the impact of Body Mass Index (BMI) on sentinel lymph-node (SLN) detection. The primary study endpoint was to investigate the impact of obesity on overall detection rate, bilateral mapping, and mapping failure rate of SLN. In addition, we evaluated possible differences in terms of surgical management and "empty-packet dissection" rate among obese and non-obese patients. METHODS: Multicenter, propensity-matched, retrospective study. Patients with apparent early-stage endometrial cancer were included. Study population was divided into women with BMI </≥ 30 (Group-1 and Group-2). To lower the selection bias, a propensity-matched analysis was performed. Matching was based on histotype (endometrioid vs non-endometrioid), age (</≥65 years old), and presence of lymph-vascular space invasion. RESULTS: Eight-hundred forty-four women were enrolled. After a 1:1 propensity-matched analysis, 764 patients were identified (Group-1 n = 382, Group-2 n = 382). A 1.156-fold increase in the risk of mapping failure for every 5 units of BMI increase was found (OR 1.156, 95% CI 1.033-1.294, p = 0.012), with a consequently decrease in bilateral mapping and overall detection rate (respectively OR 0.865, 95% CI 0.773-0.968, p = 0.012 and OR 0.785, 95% CI 0.670-0.920, p = 0.003). Obese patients were surgically under-staged in 9.4% of cases and showed an 8.2% of empty packet dissection (surgical under-staging: 5.0% vs 9.4%, p = 0.017; empty-packet dissection: 3.9% vs 8.2%, p = 0.022). CONCLUSIONS: BMI was confirmed as a statistically relevant predictor of mapping failure and decreased overall detection rate. In addition, obese women had a significantly higher odds of empty packet dissection.
Authors: Alison A Garrett; Alyssa Wield; Brigid Mumford; Isabel Janmey; Li Wang; Philip Grosse; Emily MacArthur; Ronald Buckanovich; Madeleine Courtney-Brooks; Paniti Sukumvanich; Jessica Berger; Alexander B Olawaiye; Haider Mahdi; Michelle Boisen; Robert P Edwards; Lan Coffman; Sarah E Taylor; Jamie Lesnock Journal: Gynecol Oncol Rep Date: 2022-10-07