title: The effect of body mass index on surgical outcomes and survival following pelvic exenteration.
abstract: OBJECTIVE
  We sought to evaluate whether preoperative body mass index (BMI) impacts surgical outcomes, complication rates, and/or recurrence rates in women undergoing pelvic exenteration.
  
  
  METHODS
  All women who underwent pelvic exenteration for gynecologic indications at our institution from 1993 through 2010 were included. Women were stratified into 3 groups based on BMI. Baseline characteristics, surgical outcomes, early (<60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were collected. Multivariate logistic regression analyses were performed. Kaplan-Meier survival curves were compared using log-rank test.
  
  
  RESULTS
  161 patients were included (59 normal weight, 44 overweight, 58 obese). Median follow-up times were 22, 29, and 25 months. Most patients underwent total pelvic exenteration (68%); 64.6% had a vaginal reconstruction. On multivariate analysis, both overweight and obese patients had a higher risk of early superficial wound separation compared to normal weight patients - OR 10.74 (3.33-34.62, p<0.001) and OR 4.35 (1.40-13.52, p=0.011), respectively. Length of surgery was significantly longer for overweight (9.6h, OR 1.26, 1.02-1.55, p=0.032) and obese (10.1h, OR 1.24, 1.04-1.47, p=0.014) patients than for normal weight patients (8.7h). Late postoperative complications for patients in the normal weight, overweight, and obese groups were 47.5%, 45.5%, and 43.1% (p=0.144). There were no differences in time to recurrence (p=0.752) or overall survival (p=0.103) between groups.
  
  
  CONCLUSIONS
  Although operative times were longer and risk for superficial wound separation was significantly higher, pelvic exenteration appears to be feasible and safe in overweight and obese women with overall complication rates and survival outcomes comparable to normal weight women.
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Iglesias
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.forename: Vijayashri
authors.initials: V
authors.lastname: Rallapalli
authors.forename: Marilyn
authors.initials: M
authors.lastname: Huang
authors.forename: Bryan
authors.initials: B
authors.lastname: Fellman
authors.forename: Diana
authors.initials: D
authors.lastname: Urbauer
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D050177:Overweight / Q000150:complications / Q000503:physiopathology; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult