title: Impact of obesity on surgical and oncologic outcomes in ovarian cancer.
abstract: OBJECTIVE
  The aim of this study is to determine the impact of obesity on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC).
  
  
  METHODS
  Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, recurrence and status were abstracted. Complications were graded according to the 4-point Accordion classification. For analyses, patients were divided into three groups according to body mass index (BMI): group 1-BMI <25.0 kg/m(2); group 2-BMI 25.0-39.9 kg/m(2); and group 3-BMI ≥40.0 kg/m(2).
  
  
  RESULTS
  Of the 620 patients included in the study, 36.6%, 56.9%, and 6.5% were in weight groups 1, 2, and 3, respectively. Weight group 3 was an independent predictor of severe complications after adjusting for confounders (adjusted odds ratio (95% CI): 2.93 (1.38, 6.20) for group 3 vs. group 2). Weight group was not associated with differences in residual disease (p=0.80). The 90-day mortality rates were 11.9%, 6.7%, and 15.7%, respectively, in weight group 1, 2, and 3 (p=0.049 unadjusted, p=0.01 adjusted). There was no difference in OS (p=0.52) or PFS (p=0.23) between weight groups.
  
  
  CONCLUSIONS
  BMI ≥40.0 kg/m(2) is an independent predictor of severe 30-day postoperative morbidity and 90-day mortality after PDS for EOC-information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes including residual disease at PDS, although we had limited power at the extremes of BMI. BMI may be an important factor to consider in risk-adjustment models and reimbursement strategies.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amanika
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: cliby.william@mayo.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Disease-free survival; Obesity; Ovarian cancer; Overall survival