TY - JOUR
T1 - Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis
AU - Uccella, Stefano
AU - Bonzini, Matteo
AU - Palomba, Stefano
AU - Fanfani, Francesco
AU - Ceccaroni, Marcello
AU - Seracchioli, Renato
AU - Vizza, Enrico
AU - Ferrero, Annamaria
AU - Roviglione, Giovanni
AU - Casadio, Paolo
AU - Corrado, Giacomo
AU - Scambia, Giovanni
AU - Ghezzi, Fabio
PY - 2016
Y1 - 2016
N2 - 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. Design: Retrospective case-control study (Canadian Task Force classification II-1). Setting: 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. Patients: 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. Interventions: Laparoscopic or open surgical treatment for endometrial cancer. Measurements and Main 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. Conclusion: 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.
AB - 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. Design: Retrospective case-control study (Canadian Task Force classification II-1). Setting: 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. Patients: 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. Interventions: Laparoscopic or open surgical treatment for endometrial cancer. Measurements and Main 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. Conclusion: 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.
KW - 80 and over
KW - Adult
KW - Aged
KW - Complication
KW - Endometrial Neoplasms
KW - Endometrial cancer
KW - Female
KW - Humans
KW - Hysterectomy
KW - Laparoscopy
KW - Matched-Pair Analysis
KW - Medicine (all)
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures
KW - Morbid obesity
KW - Obese
KW - Obesity
KW - Obstetrics and Gynecology
KW - Postoperative Complications
KW - Propensity Score
KW - Retrospective Studies
KW - Surgery
KW - Treatment Outcome
KW - 80 and over
KW - Adult
KW - Aged
KW - Complication
KW - Endometrial Neoplasms
KW - Endometrial cancer
KW - Female
KW - Humans
KW - Hysterectomy
KW - Laparoscopy
KW - Matched-Pair Analysis
KW - Medicine (all)
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures
KW - Morbid obesity
KW - Obese
KW - Obesity
KW - Obstetrics and Gynecology
KW - Postoperative Complications
KW - Propensity Score
KW - Retrospective Studies
KW - Surgery
KW - Treatment Outcome
UR - https://publicatt.unicatt.it/handle/10807/91909
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84952631583&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84952631583&origin=inward
U2 - 10.1016/j.jmig.2015.08.007
DO - 10.1016/j.jmig.2015.08.007
M3 - Article
SN - 1553-4650
VL - 23
SP - 53
EP - 61
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 1
ER -