title: Surgical safety and personal costs in morbidly obese, multimorbid patients diagnosed with early-stage endometrial cancer having a hysterectomy.
abstract: BACKGROUND
  Many women who develop endometrial cancer (EC) or endometrial hyperplasia with atypia are obese and therefore at high risk of surgical complications. Recently clinical trials have been initiated offering non-surgical treatment to these women, but not all may agree to participate in such trials. This paper aims to describe the patient characteristics, and surgical outcomes of women with suspected early stage endometrial cancer and body mass index (BMI) of 30 or greater, who declined enrolment in the feMMe trial, which offers non-surgical hormonal treatment, hormonal plus metformin or hormonal plus weight loss as primary treatment.
  
  
  METHODS
  Consecutive case series from a tertiary gynaecological oncology unit. Over the course of the first 2 years of the feMMe trial, 27 patients met the initial eligibility screening, but declined enrolment in the feMMe trial and opted for upfront surgery. The main surgical outcome measures were type of surgical approach, need for conversion from laparoscopic to open approach, length of stay in hospital and adverse events.
  
  
  RESULTS
  Patients' median age was 63 years (range 40 to 86); median BMI was 37.3 kg/m2 (range 30.7 to 54.7); median medical co-morbidities were six (range 3-10). Of the 26/27 surgeries planned to be undertaken laparoscopically, 2/26 patients had to be converted (7 %). Overall, the average hospital stay was 4.5 days, and 11/27 (41 %) of the patients developed one or more adverse events grade 2+ rated according to the Common Toxicity Criteria Version 3.
  
  
  CONCLUSIONS
  Adverse surgical outcomes are common in multi-morbid, obese or morbidly obese patients diagnosed with early stage EC or endometrial hyperplasia with atypia and who have a hysterectomy.
authors.affiliation: Queensland Centre for Gynaecological Cancer, The University of Queensland, Brisbane, QLD Australia ; Greenslopes Private Hospital, Brisbane, QLD Australia ; Queensland Centre for Gynaecological Cancer, c/o Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD 4029 Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
authors.affiliation: Rotunda Hospital, Dublin, Ireland.
authors.forename: Donal J
authors.initials: DJ
authors.lastname: Brennan
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia.
authors.forename: Eva
authors.initials: E
authors.lastname: Baxter
authors.affiliation: Anatomical Pathology Mater Health Services, Mater Adult Hospital, and Mater Research Institute-University of Queensland, Brisbane, QLD Australia.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Armes
authors.affiliation: University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW Australia.
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
authors.affiliation: School of Public Health, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
keywords: Adverse event; Endometrial cancer; Endometrial hyperplasia with atypia; Obesity; Surgery