Computed Tomography Morphometrics and Pulmonary Intolerance in Endometrial Cancer Robotic Surgery

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• 作者：Ahmed Y. Abdelbadee ; MBBCh ; MSc^a ; ^b ; Raj M. Paspulati ; MD ; FSAR^c ; Heather D. McFarland ; DO^d ; Mohamed A. Bedaiwy ; MD ; PhD ; FACOG ; FRCS^b ; ^e ; Leslie Ciancibello ; RT ; R (CT)^c ; Gina Anderson ; RT ; R (CT)^c ; Kristine M. Zanotti ; MD^a ; ^{Kristine.Zanotti@UHhospitals.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Computed tomography morphometrics ; Endometrial cancer ; Pulmonary intolerance ; Robotic pelvic surgery ; Visceral adiposity
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：23
• 期：7
• 页码：1075-1082
• 全文大小：691 K

文摘

To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution.

Design

Retrospective study (Canadian Task Force classification II-2).

Setting

University hospital.

Patients

Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year.

Intervention

Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were quantified through waist circumference measurements along with average volume estimation of slices taken at 3 levels: mid-waist, L2-L3, and L4-L5. Mean and maximum values were obtained for intraoperative physiological data.

Measurements and Main Results

The patients' mean body mass index (BMI) was 34 (range, 20–59). Along with waist circumference, VFV and SFV quantified by CT at the mid-waist, L2-L3, and L4-L5 levels were all significant independent predictors for peak airway pressure (PAP; average and maximum) and plateau airway pressure (Pplat; average and maximum) on multivariate regression analysis after adjustment for age, ethnicity, diabetes, hypertension, pulmonary disease, smoking, obstructive sleep apnea, American Society of Anesthesiologists classification, and duration of anesthesia. Compared with the other CT parameters, L2-L3 VFV was the best predictor of average PAP (β = 0.398; p = .002), maximum PAP (β = 0.493; p < .001), average Pplat (β = 0.536; p < .001), and maximum Pplat (β = 0.573; p < .001).

Conclusion

These novel CT morphometric measurements represent valid predictors of pulmonary intolerance to robotic surgery in obese patients. Of the measures analyzed, VFV at L2-L3 best predicts pulmonary tolerance in obese patients.