title: Radical hysterectomy in obese and morbidly obese women with cervical cancer.
abstract: OBJECTIVE
  To compare intraoperative and postoperative outcomes, pathologic findings, cancer recurrence, and death rates in normal-weight, overweight, obese, and morbidly obese women undergoing radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer.
  
  
  METHODS
  A review of patients who underwent radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer between 1990 and 2006 was performed. On the basis of body mass index (BMI) (calculated as weight [kg]/[height (m)](2)), women were categorized as normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese (BMI 30.0-34.9), or morbidly obese (BMI at least 35.0).
  
  
  RESULTS
  Four hundred eight women met the inclusion criteria. Of these, 155 (38%) were normal weight, 126 (31%) were overweight, 77 (19%) were obese, and 50 (12%) were morbidly obese. There were no statistically significant differences between these four groups in age, Charlson comorbidity score, smoking history, stage, histologic grade or subtype, tumor size, depth of invasion, transfusion rate, operative time, or intraoperative complications. Higher BMI was significantly correlated with higher estimated operative blood loss (P=.001). There were no statistically significant differences between the groups in pathologic findings, length of postoperative hospital stay, postoperative complications, readmission rate, or proportion of women receiving adjuvant radiotherapy. At a median follow-up time of 64 months, there were no differences between groups in rates of recurrence or death from disease.
  
  
  CONCLUSIONS
  Radical hysterectomy and pelvic lymphadenectomy is feasible for obese and morbidly obese women with cervical cancer. Obesity alone should not be a contraindication to radical hysterectomy in women with cervical cancer.
authors.affiliation: Departments of Gynecologic Oncology and Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. mfrumovitz@mdanderson.org
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dos Reis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Milam
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Kristal
authors.initials: K
authors.lastname: Taylor
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D009765:Obesity / Q000453:epidemiology*; D009767:Obesity, Morbid / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000601:surgery*