Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis

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• 作者：Stefano Uccella ; MD ; PhD^a ; ^{stefucc@libero.it" class="auth_mail" title="E-mail the corresponding author} ; Matteo Bonzini ; MD^b ; Stefano Palomba ; MD^c ; Francesco Fanfani ; MD^d ; Marcello Ceccaroni ; MD^e ; Renato Seracchioli ; MD^f ; Enrico Vizza ; MD^g ; Annamaria Ferrero ; MD^h ; Giovanni Roviglione ; MD^e ; Paolo Casadio ; MD^f ; Giacomo Corrado ; MD ; PhD^g ; Giovanni Scambia ; MD^d ; Fabio Ghezzi ; MD^a
• 关键词：Complication ; Endometrial cancer ; Laparoscopy ; Morbid obesity ; Obese ; Surgery
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：23
• 期：1
• 页码：53-61
• 全文大小：677 K

文摘

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.

absSec_2">Design

abspara0015">Retrospective case-control study (Canadian Task Force classification II-1).

absSec_3">Setting

abspara0020">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.

absSec_4">Patients

abspara0025">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.

absSec_5">Interventions

abspara0030">Laparoscopic or open surgical treatment for endometrial cancer.

absSec_6">Measurements and Main Results

abspara0035">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.

absSec_7">Conclusion

abspara0040">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.