Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis.
OBJECTIVE
To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach.


METHODS
Retrospective case-control study (Canadian Task Force classification II-1).


METHODS
Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy.


METHODS
Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching.


METHODS
Laparoscopic or open surgical treatment for endometrial cancer.


RESULTS
A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI <40, but increased in those with BMI ≥40 (8.6%; p = .05). PS analysis showed a lower complication rate, shorter hospital stay, and greater likelihood of receiving lymphadenectomy in obese women in the laparoscopic group.


CONCLUSIONS
Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese patients can be challenging regardless of the surgical approach taken, especially in cases of morbid adiposity.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it.
Stefano
S
Uccella
Epidemiology and Preventive Medicine Research Center, Insubria University, Varese, Italy.
Matteo
M
Bonzini
Unit of Obstetrics and Gynecology, IRCCS-ASMN of Reggio Emilia, Italy.
Stefano
S
Palomba
Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
Francesco
F
Fanfani
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
Marcello
M
Ceccaroni
Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Renato
R
Seracchioli
Department of Oncological Surgery, Gynecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.
Enrico
E
Vizza
Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy.
Annamaria
A
Ferrero
Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
Giovanni
G
Roviglione
Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Paolo
P
Casadio
Department of Oncological Surgery, Gynecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.
Giacomo
G
Corrado
Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
Giovanni
G
Scambia
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Fabio
F
Ghezzi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016555:Matched-Pair Analysis; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
Complication; Endometrial cancer; Laparoscopy; Morbid obesity; Obese; Surgery