Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

Abstract

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population. Material and methods: Endometrial cancer patients' archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m 2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not. Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively). Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.

Impact of lymphadenectomy on short- and long-term complications in patients with endometrial cancer

“…Only 15% of our patients who underwent a systematic lymphadenectomy had positive lymph nodes (lymph node metastases). This is in line with other studies, in which a mere 15-20% of patients had positive lymph nodes after lymphadenectomy [29]. Muallem [31].…”

“…The risk of postoperative complications is known to be highest when this approach is used. In the future, robotassisted surgery will probably permit surgeons to use the laparoscopic approach even in morbidly obese patients and thus reduce surgical complications [29,35,36]. Additionally, the sentinel node biopsy has recently become a standard procedure and is recommended by the latest ESGO guideline [37].…”

Impact of Lymphadenectomy on Short- and Long-term Complications in Patients With Endometrial Cancer

“…Only 15 % of our patients who underwent a systematic lymphadenectomy had positive lymph nodes (lymph node metastases). This is in line with other studies, in which a mere 15-20 % of patients had positive lymph nodes after lymphadenectomy [27]. Muallem [11,29].…”

Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study

“…In a study comparing patients with a BMI > 40 kg/m 2 with those with normal weight, Pavelka et al found similar results (12). This difference in surgical management could be explained by added surgical complexity and postoperative complications in the obese population (9,20,21). The surgeon may well choose to reduce the complexity of the procedure and its potential morbidities by not performing a complete lymphadenectomy thereby avoiding conversion to laparotomy.…”

“…Urunsak et al showed that the absence of lymphadenectomy had no influence on survival in their population of severely obese women (BMI >40 kg/m 2 ), irrespective of the risk of recurrence (21). Nevertheless, a meta-analysis by Kim et al showed that systematic lymphadenectomy did improve OS in women with high-risk endometrial cancer (26).…”