Relative Morbidity and Mortality of Panniculectomy-Combined Surgical Staging in Endometrial Cancer.
OBJECTIVE
To examine intraoperative and postoperative complication rates for surgical staging combined with panniculectomy for endometrial cancer.


METHODS
A prospectively collected institutional surgical database was used to identify patients with endometrial cancer who underwent hysterectomy-based surgical staging between December 2008 and August 2014 (n = 551). The cases were grouped into surgical staging with panniculectomy (panniculectomy group, n = 11 [2.0%]), laparotomy without panniculectomy (laparotomy group, n = 208 [37.7%]), and laparoscopy (minimally invasive surgery group, n = 332 [60.3%]). Major complication and surgical wound complication rates within 30 days from surgery were compared.


RESULTS
The panniculectomy group had a significantly higher body mass index compared with other approaches (panniculectomy group, laparotomy group, and minimally invasive surgery group: 60.4, 35.7, and 34.1; P < 0.001) and had a high stage I disease rate (90.9%, 61.5%, and 88.3%; P < 0.001). Mean pannus weight was 5733 g (4.4% of body weight). Intraoperative major complication rates were statistically nonsignificant across the groups (0%, 7.2%, and 4.2%; P = 0.23); however, the panniculectomy group had a significantly higher postoperative major complication rate compared with other approaches (36.4%, 16.3%, and 5.1%; P < 0.001). In multivariate analysis controlling for age, ethnicity, body habitus, medical comorbidities, and tumor factors, panniculectomy remained an independent predictor for increased risk of postoperative major complications (adjusted odds ratio, 4.37; P = 0.043). Surgical mortality rates were similar across the groups (0%, 0.5%, and 0%; P = 0.44). Among superobese patients (n = 50), intraoperative and postoperative complication rates were statistically similar across the 3 groups (all, P > 0.05).


CONCLUSIONS
Although panniculectomy-combined surgical staging is associated with an increased risk of postoperative complications, the majority recovered uneventfully, making this approach a feasible treatment option, especially for superobese patients with endometrial cancer.
*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and †Division of Plastic and Reconstructive Surgery, Department of Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles; and ‡Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Amin A
AA
Ramzan
Jocelyn
J
Garcia-Sayre
Marianne S
MS
Hom
Kyle A
KA
Graham
Joseph N
JN
Carey
Laila I
LI
Muderspach
Koji
K
Matsuo
D061645:Abdominoplasty / Q000401:mortality*; D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000401:mortality*; D010535:Laparoscopy / Q000401:mortality*; D007813:Laparotomy / Q000401:mortality*; D008875:Middle Aged; D009017:Morbidity; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies