title: Impact of body mass index on surgical outcomes and analysis of disease recurrence for patients with endometrial cancer undergoing robotic-assisted staging.
abstract: OBJECTIVE
  This study aimed to evaluate the impact of body mass index (BMI) on the short- and long-term outcomes of patients with endometrial cancer who underwent robotic-assisted staging and to analyze disease recurrence and recurrence-free survival (RFS).
  
  
  METHODS
  The charts of all consecutive patients with endometrial cancer who underwent robotic surgery from March 2007 to October 2012 were analyzed. Patients with follow-up less than 12 months after surgery were censored from the RFS analysis.
  
  
  RESULTS
  Mean (SD) age for the 364 patients was 63.6 (10) years, and mean (SD) BMI was 34.8 (10.1) kg/m. Conversions were in 3 (0.8%) of 364 cases. The mean (SD) operative time was 162.3 (54.6) minutes. Mean (SD) postoperative hospitalization was 1.6 (1.9) days. Histology included 80.5% endometrioid and 19.5% clear cell, serous, and carcinosarcomas. Mean (SD) pelvic and paraaortic lymph node counts were 15.9 (8.2) and 3.6 (4.3), respectively. Metastatic disease was diagnosed in 58 (16%) of 364 patients. The median follow-up was 29.3 months. The recurrence rates were 4.1% for the patients with endometrioid carcinoma and 14.1% for nonendometrioid histologies. Recurrences in patients with BMI less than 30 kg/m accounted for 68.2% of all recurrences (15/22 patients). The rest of recurrences (7/22 patients, 31.8%) were in obese patients. Moreover, when analyzed for each histologic subtype, recurrence rates were consistently higher for patients with BMI less than 30 kg/m when compared with patients with BMI greater than 30 kg/m. The 3-year overall survival was 98.2%, and the 3-year RFS was 92%.
  
  
  CONCLUSIONS
  Obesity and morbid obesity did not affect adversely the operative outcomes for patients with endometrial cancer who were operated on using the robotic system. The recurrence rates were lower for patients with BMI greater than 30 kg/m compared with patients with BMI less than 30 kg/m for both endometrioid and nonendometrioid cancers.
authors.affiliation: *School of Medicine, and †School of Public Health, Yale University, New Haven, CT.
authors.forename: Gulden
authors.initials: G
authors.lastname: Menderes
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
authors.forename: Lindsay
authors.initials: L
authors.lastname: Clark
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Lingeng
authors.initials: L
authors.lastname: Lu
authors.forename: Elena
authors.initials: E
authors.lastname: Ratner
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Rutherford
authors.forename: Alessandro D
authors.initials: AD
authors.lastname: Santin
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002296:Carcinosarcoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate