Advertisement

Obesity Surgery

, Volume 29, Issue 10, pp 3285–3290 | Cite as

Obesity in Patients with Endometrial Cancer: May It Affect the Surgical Outcomes of Laparoscopic Approach?

  • Z. M. Gambacorti-PasseriniEmail author
  • C. López-De la Manzanara Cano
  • C. Pérez Parra
  • M. C. Cespedes Casas
  • L. Sánchez Hipólito
  • C. Martín Francisco
  • J. R. Muñoz-Rodríguez
Original Contributions
  • 109 Downloads

Abstract

Objective

To evaluate the impact of obesity on surgical outcomes for women with endometrial cancer (EC) managed by laparoscopic surgery. Minimal invasive surgery has been incorporated in the surgical management of EC, improving perioperative outcomes. However, this approach may become more challenging in case of obesity. So it is important to accurately evaluate and establish the most appropriate surgical approach for these patients.

Materials and Methods

From January 2008 through April 2016, we conducted a prospective observational study, including all consecutive patients with a histological diagnosis of EC undergoing surgical staging by laparoscopy at our institution. Patients were classified in two groups (obese vs non-obese) according to their body mass index. Information about short- and long-term outcomes were recorded and analyzed during an outpatient follow-up.

Results

Between January 2008 and April 2016, 83 women underwent laparoscopic surgery for EC at our institution. Forty-six (56.6%) of them were classified as obese. Surgical outcomes were similar in both groups. No significant difference was reported in surgical time, number of lymph nodes removed, blood loss, length of hospital stay, and incidence of intra- or postoperative complications. Also, long-term outcomes did not show any statistical significant difference: recurrence rate was 6.4% (3/47) among obese patients and 13.9% (5/36) among non-obese (p = 0.251). No difference was reported even in time to recurrence (log-rank p = 0.280) and in survival time (log-tank p = 0.132) between the two groups.

Conclusions

Our results show that obesity did not impair the outcomes of laparoscopic surgery for EC. This surgical approach may be offered to obese patients with the same level of safety, radicality, and efficiency as for the normal-weight population.

Keywords

Endometrial cancer Laparoscopy Obesity Surgical approach 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there are no conflicts of interest.

Statement of Institutional Review Board Approval

The Ethics Committee of our Institutions does not require an approval for this kind of research, as this is an observational study.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.CrossRefGoogle Scholar
  2. 2.
    Kondalsamy-Chennakesavan S, Janda M, Gebski V, et al. Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. Eur J Cancer. 2012;48:2155–62.CrossRefGoogle Scholar
  3. 3.
    Shaw E, Farris M, McNeil J, et al. Obesity and endometrial cancer. Recent Results Cancer Res. 2016;208:107–36.CrossRefGoogle Scholar
  4. 4.
    Bittoni MA, Fisher JL, Fowler JM, et al. Assessment of the effects of severe obesity and lifestyle risk factors on stage of endometrial cancer. Cancer Epidemiol Biomark Prev. 2013;22:76–81.CrossRefGoogle Scholar
  5. 5.
    Mahdi H, Jernigan AM, Alijebori Q, et al. The impact of obesity on the 30-day morbidity and mortality after surgery for endometrial cancer. J Minim Invasive Gynecol. 2015;22:94–102.CrossRefGoogle Scholar
  6. 6.
    Schmandt RE, Iglesas DA, Co NN, et al. Understanding obesity and endometrial cancer risk: opportunities for prevention. Am J Obstet Gynecol. 2011;205:518–25.CrossRefGoogle Scholar
  7. 7.
    Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Cancer Netw. 2014;12:288–97.CrossRefGoogle Scholar
  8. 8.
    Gunderson CC, Java J, Moore KN, et al. The impact of obesity on surgical staging, complications, and survival with uterine cancer: gynecologic oncology group LAP2 ancillary data study. Gynecol Oncol. 2014;133:23–7.CrossRefGoogle Scholar
  9. 9.
    Palomba S, Falbo A, Mocciaro R, et al. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials. Gynecol Oncol. 2009;112:415–21.CrossRefGoogle Scholar
  10. 10.
    Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomized trial. Lancet Oncol. 2010;11:762–71.CrossRefGoogle Scholar
  11. 11.
    Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012;30:695–700.CrossRefGoogle Scholar
  12. 12.
    Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009;27:5331–6.CrossRefGoogle Scholar
  13. 13.
    Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.CrossRefGoogle Scholar
  14. 14.
    Von Gruenigen VE, Gil KM, Frasure HE, et al. The impact of obesity and age on quality of life in gynecologic surgery. Am J Obstet Gynecol. 2005;193:1369–75.CrossRefGoogle Scholar
  15. 15.
    Catalán V, Gómez-Ambrosi J, Rodríguez A, et al. Adipose tissue immunity and cancer. Front Physiol. 2013;4:275.CrossRefGoogle Scholar
  16. 16.
    Perez-Hernandez AI et al. Mechanisms linking excess adiposity and carcinogenesis promotion. Front Endocrinol. 2014;5:65.Google Scholar
  17. 17.
    Gomez-Ambrosi J et al. Involvement of leptin in the association between percentage of body fat and cardiovascular risk factors. Clin Biochem. 2002;35:315–20.CrossRefGoogle Scholar
  18. 18.
    Catalán V, Gómez-Ambrosi J, Rodríguez A, et al. Expression of caveolin-1 in human adipose tissue is upregulated in obesity and obesity-associated type 2 diabetes mellitus and related to inflammation. Clin Endocrinol. 2008;68:213–9.Google Scholar
  19. 19.
    Gómez-Ambrosi J, Salvador J, Rotellar F, et al. Increased serum amyloid a concentrations in morbid obesity decrease after gastric bypass. Obes Surg. 2006;16:262–9.CrossRefGoogle Scholar
  20. 20.
    Gallego-Escuredo JM, Gómez-Ambrosi J, Catalan V, et al. Opposite alterations in FGF21 and FGF19 levels and disturbed expression of the receptor machinery for endocrine FGFs in obese patients. Int J Obes. 2015;39:121–9.CrossRefGoogle Scholar
  21. 21.
    Kazaure HS, Roman SA, Sosa JA. Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy. World J Surg. 2011;35:1287–95.CrossRefGoogle Scholar
  22. 22.
    Suidan RS, He W, Sun CC, et al. Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia. Gynecol Oncol. 2017;145:55–60.CrossRefGoogle Scholar
  23. 23.
    Uccella S, Bonzini M, Palomba S, et al. Impact of obesity on surgical treatment for endometrial cancer: a multicenter study comparing laparoscopy vs open surgery, with propensity-matched analysis. J Minim Invasive Gynecol. 2016;23:53–61.CrossRefGoogle Scholar
  24. 24.
    O’Hanlan JA, Dibble SL, Fisher DT. Total laparoscopic hysterectomy for uterine pathology: impact of body mass index on outcomes. Gynecol Oncol. 2006;103:938–41.CrossRefGoogle Scholar
  25. 25.
    Helm CW, Arumugam C, Gordinier ME, et al. Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications. J Gynecol Oncol. 2011;22:168–76.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Z. M. Gambacorti-Passerini
    • 1
    Email author
  • C. López-De la Manzanara Cano
    • 1
    • 2
  • C. Pérez Parra
    • 1
    • 3
  • M. C. Cespedes Casas
    • 1
  • L. Sánchez Hipólito
    • 1
  • C. Martín Francisco
    • 1
  • J. R. Muñoz-Rodríguez
    • 4
  1. 1.Department of Obstetrics and GynecologyCiudad Real University General HospitalCiudad RealSpain
  2. 2.University of Castilla-La ManchaCiudad RealSpain
  3. 3.Department of Obstetrics and GynecologyAlbacete University HospitalAlbaceteSpain
  4. 4.Translational Research UnitCiudad Real University General HospitalCiudad RealSpain

Personalised recommendations