title: The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature.
abstract: OBJECTIVE
  We aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature.
  
  
  METHODS
  This was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI <30kg/m(2), BMI ≥30kg/m(2) and BMI ≥40kg/m(2). The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
  
  
  RESULTS
  In total, we identified 627 women of which 514 were included; 249 women had a BMI of <30kg/m(2), 195 women had a BMI of 30-39.9kg/m(2), and 70 women were morbidly obese (BMI ≥40kg/m(2)). Obese women (BMI ≥30kg/m(2)) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality.
  
  
  CONCLUSIONS
  Obesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.
authors.affiliation: Radboud UMC, Nijmegen, The Netherlands.
authors.forename: Frederique
authors.initials: F
authors.lastname: Bouwman
authors.affiliation: Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom.
authors.forename: Anke
authors.initials: A
authors.lastname: Smits
authors.affiliation: Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom.
authors.forename: Alberto
authors.initials: A
authors.lastname: Lopes
authors.affiliation: Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom.
authors.forename: Nagindra
authors.initials: N
authors.lastname: Das
authors.affiliation: European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Pollard
authors.affiliation: Radboud UMC, Nijmegen, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Massuger
authors.affiliation: Radboud UMC, Nijmegen, The Netherlands.
authors.forename: Ruud
authors.initials: R
authors.lastname: Bekkers
authors.affiliation: Royal Cornwall Hospital Trust, Truro, Cornwall, United Kingdom. Electronic address: khadra.galaal@rcht.cornwall.nhs.uk.
authors.forename: Khadra
authors.initials: K
authors.lastname: Galaal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D009767:Obesity, Morbid / Q000150:complications*; D050177:Overweight / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Body mass index; Endometrial cancer; Obesity; Surgical complications; Surgical outcomes