Abstract
Objective
Obesity is a significant risk factor in developing endometrial cancer. As obesity is becoming more endemic, we wish to evaluate the impact of obesity on perioperative outcomes in patients undergoing uterine cancer surgery.
Methods
We analyzed our prospective database on patients with endometrial cancer who underwent abdominal hysterectomy and pelvic/aortic lymphadenectomy by one gynecologic oncologist. Information regarding race, age, body mass index (BMI), lymph node counts, staging, and estimated blood loss were analyzed against patient’s weight category. Weight category was divided as follows: Normal weight (BMI < 25), overweight (BMI 25 to <30), obese (BMI 30 to <35) and morbid obesity (BMI ≥ 35).
Results
Between April 2003 and December 2009, 233 patients were recruited prospectively. This study found no difference in the number of lymph nodes harvested patient (P = 0.0539) or length of hospital stay (P = 0.4234) in patients with a normal BMI versus that of an overweight, obese, or morbidly obese. However, estimated blood loss (P = 0.01) and operative time (P = 0.0015) were greater as BMI increased. African American patients were more morbidly obese than Caucasian patients. Furthermore, younger patients tend to be more obese across all races. Finally, obesity did not affect perioperative complications (P = 0.78).
Conclusion
Obesity increases surgical blood loss and operative time. However, obesity does not affect length of hospital stay, number of lymph nodes harvested, or perioperative complications in uterine cancer staging surgery.
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References
Center for Disease Control. Data and statistics: US Obesity Trends, http://www.cdc.gov/obesity/data/trends.html. Retrieved September 9, 2010
Lane G (2008) Obesity and gynecological cancer. Menopause Int 14(1):33–37
Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A et al (2005) Cancer statistics. CA Cancer J Clin 55:10–30
Eisenhauer EL, Wypych KA, Mehrara BJ, Lawson C, Chi DS, Barakat RR, Abu Rustum NR (2007) Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy. Ann Surg Oncol 14(8):2384–2391
Derossis AM, Fey JV, Cody HS 3rd, Borgen PI (2003) Obesity influences outcome of sentinel lymph node biopsy in early-stage breast cancer. J Am Coll Surg 197(6):896–901
Li SK, Zhou YB, Zhou CF, Wang PG, Wang HB, Mao WZ, Wang ZG (2010) Influence of obesity on short-term surgical outcome in patients with gastric cancer Zhonghua Wei Chang Wai Ke Za Zhi 13(2):133–136
Deglise C, Bouchardy C, Burri M, Usel M, Neyroud-Caspar I, Vlastos G, Chappuis PO, Ceschi M, Ess S, Castiglione M, Rapiti E, Verkooijen HM (2010) Impact of obesity on diagnosis and treatment of breast cancer. Breast Cancer Res Treat 120(1):185–193
Helyer LK, Varnic M, Le LW, Leong W, McCready D (2009) Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J 16(1):48–54
Daniell HW (1988) Increased lymph node metastases at mastectomy for breast cancer associated with host obesity, cigarette smoking, age, and large tumor size. Cancer 62(2):429–435
Fleming JB, Gonzalez RJ, Petzel MQ, Lin E, Morris JS, Gomez H, Lee JE, Crane CH, Pisters PW, Evans DB (2009) Influence of obesity on cancer-related outcomes after pancreatectomy to treat pancreatic adenocarcinoma. Arch Surg 144(3):216–221
Ludwig MS, Goodman M, Miller DL, Johnstone PA (2005) Postoperative survival and the number of lymph nodes sampled during resection of node-negative nonsmall cell lung cancer. Chest 128(3):1545–1550
Bui L, Rempel E, Reeson D, Simunovic M (2006) Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: a population-based study. J Surg Oncol 93(6):439–445
Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC, Mazumdar M (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248(2):221–226
Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM, Hölscher A, Lerut T, Law S, Rice TW, Ruol A, van Lanschot JJ, Wong J, DeMeester TR (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248(4):549–556
Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP (2008) Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer 112(6):1239–1246
Hollenbeck BK, Ye Z, Wong SL, Montie JE, Birkmeyer JD (2008) Hospital lymph node counts and survival after radical cystectomy. Cancer 112(4):806–812
Vather R, Sammour T, Zargar-Shoshtari K, Metcalf P, Connolly A, Hill A (2009) Lymph node examination as a predictor of long-term outcome in Dukes B colon cancer. Int J Colorectal Dis 24(3):283–288
Ballian N, Yamane B, Leverson G, Harms B, Heise CP, Foley EF, Kennedy GD (2010) Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma. Ann Surg Oncol 17(6):1606–1613
Erkanli S, Kayaselçuk F, Bagis T, Kuşçu E (2006) Impact of morbid obesity in surgical management of endometrial cancer: surgical morbidity, clinical and pathological aspects. Eur J Gynaecol Oncol 27(4):401–404 [27(5):448]
Salman MC, Usubutun A, Ozlu T, Boynukalin K, Yuce K (2010) Obesity does not affect the number of retrieved lymph nodes and the rate of intraoperative complications in gynecologic cancers. J Gynecol Oncol 21(1):24–28
Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T (1993) Do obese children become obese adults? A review of the literature. Prev Med 22(2):167–177
Center for Disease Control. Obesity by Race/Ethnicity 2006–2008. http://www.cdc.gov/obesity/data/trends.html#Race. Accessed 19 Sept 2010
Targher G, Zoppini G, Moghetti P, Day CP (2010) Disorders of coagulation and hemostasis in abdominal obesity: emerging role of fatty liver. Semin Thromb Hemost 36(1):41–48
Santoso JT, Dinh T, Omar S, Gei A, Hannigan EV (2001) Surgical blood loss in abdominal hysterectomy. Gynecol Oncol 82:364–366
Seamon LG, Bryant SA, Rheaume PS, Kimball KJ, Huh WK, Fowler JM, Phillips GS, Cohn DE (2009) Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy. Obstet Gynecol 114(1):16–21
Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC (2010) Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol 117(2):224–228
Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby GE, Pikaart DP 4th, Finkler NJ (2009) Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol 115(3):447–452
O’Hanlan KA, Dibble SL, Fisher DT (2006) Total laparoscopic hysterectomy for uterine pathology: impact of body mass index on outcomes. Gynecol Oncol 103(3):938–941
Yu X, Books R, Lum D, Kiet T, Fuh K, Orr J, Kapp D, Chan J (2011) Trends in utilization and cost of minimally invasive robotic surgery for endometrial cancer: a statewide analysis. Gynecol Oncol 120:S23
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Santoso, J.T., Barton, G., Riedley-Malone, S. et al. Obesity and perioperative outcomes in endometrial cancer surgery. Arch Gynecol Obstet 285, 1139–1144 (2012). https://doi.org/10.1007/s00404-011-2116-2
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DOI: https://doi.org/10.1007/s00404-011-2116-2