The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—An institutional study and systematic review of the literature

Bouwman, Frederique; Smits, Anke; Lopes, Alberto; Das, Nagindra; Pollard, Adam; Massuger, Leon F.A.G.; Bekkers, Ruud L.M.; Galaal, Khadra

doi:10.1016/j.ygyno.2015.09.020

Cited by 128 publications

(87 citation statements)

References 30 publications

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“…When we stratified patients by surgical approach, it became apparent that the difference in complications was driven by the subset of patients undergoing open surgery and was not seen in those undergoing MIS. Other retrospective reports assessing patients who underwent laparotomy found a higher wound complication rate with a higher BMI, but no differences in other complication types [21, 22]. In our analysis, there was no difference in the overall rate of complications across different BMI groups.…”

Section: Discussioncontrasting

confidence: 50%

Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia

Suidan

Sun

et al. 2017

Gynecologic Oncology

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Objective To assess the impact of body mass index (BMI) and operative approach on surgical morbidity and costs in patients with endometrial carcinoma (EC) and hyperplasia (EH). Methods All women with BMI data who underwent surgery for EC or EH from 2008–2014 were identified from MarketScan, a healthcare claims database. Differences in 30-day complications and costs were compared between BMI groups and stratified by surgical modality. Results Of 1,112 patients, 35%, 36%, and 29% had a BMI of ≤29, 30–39, and ≥40 kg/m2, respectively. Compared to patients with a BMI of 30–39 and ≤29, women with a BMI ≥40 had higher rates of venous thromboembolism (3% vs 0.2% vs 0.3%, p<.01) and wound infection (7% vs 3% vs 3%, p=.02). This increase was driven by the subset of patients who had laparotomy and was not seen in those undergoing minimally invasive surgery (MIS). Median total costs for women with a BMI ≥40, 30–39, and ≤29 were U.S. $17.3k, $16.8k, and $16.6k respectively (p=.53). Costs were higher for patients who had laparotomy than those who had MIS across all BMI groups, with the cost difference being highest in morbidly obese women (≥40: $21.6k vs $14.9k, p<.01; 30–39: $18.9k vs $16.1k, p=.01; ≤29: $19.3k vs $15k, p<.01). Patients who had complications had higher costs compared to those who did not, with a higher cost difference in the laparotomy group ($27.7k vs $16.4k, p<.01) compared to the MIS group ($19.9k vs $15k, p<.01). Conclusions MIS may increase the value of care by minimizing complications and decreasing costs. This may be most pronounced in morbidly obese women.

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Section: Discussioncontrasting

confidence: 50%

Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia

Suidan

Sun

et al. 2017

Gynecologic Oncology

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“…Furthermore, all 5 identified studies assessing laparoscopy in their systematic review reported no significant differences in operative complications and outcomes between obese and nonobese patients. 13 Therefore, data from their systematic review align with results from our study, suggesting that laparoscopy is safe and feasible in patients with an increased BMI. Because laparoscopy can be challenging to perform in obese patients, many institutions have shifted their practice to robotic-assisted surgery.…”

Section: Discussionsupporting

confidence: 81%

“…A retrospective study and systematic review by Bouwman et al evaluating the surgical management (including laparotomies as well as minimally invasive surgeries) of obese women with endometrial cancer reported similar outcomes to those observed in this current study, including longer operative times and no difference in conversion rates between obese and nonobese patients. 13 Although Bouwman et al demonstrated that obese women were at a higher risk of developing surgical complications and had increased morbidity, the high rate of laparotomy in their study (950%) may partially explain the observed differences. Furthermore, all 5 identified studies assessing laparoscopy in their systematic review reported no significant differences in operative complications and outcomes between obese and nonobese patients.…”

Section: Discussionmentioning

confidence: 75%

“…However, all of these studies have had small obese patient cohorts (fewer than 55 patients) and none included morbidly obese patients (BMI Q 40 kg/m 2 ) as a separate category. 13,22Y26 Therefore, a strength of this study is the large proportion of obese and morbidly obese patients. Future prospective studies should be conducted to validate the results of this study and to compare laparoscopy to robotic surgery in the management of obese and morbidly obese patients with gynecologic cancers.…”

Section: Discussionmentioning

confidence: 99%

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The Feasibility of Laparoscopic Surgery in Gynecologic Oncology for Obese and Morbidly Obese Patients

Peng

Sinasac

Pulman

et al. 2018

Int J Gynecol Cancer

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“…Morbid obesity itself may limit surgical options and increase surgical morbidity, [17][18][19] increase toxicity from radiation, 20,21 and lead to under-dosing of chemotherapy. Morbid obesity itself may limit surgical options and increase surgical morbidity, [17][18][19] increase toxicity from radiation, 20,21 and lead to under-dosing of chemotherapy.…”

Section: Phenotypes In Patients With Ec and The Opportunities For Lifmentioning

confidence: 99%

Endometrial cancer: Not your grandmother's cancer

McAlpine

Temkin

Mackay

2016

Cancer

147

110

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Worldwide, the incidence of endometrial carcinoma (EC) is rapidly increasing, and the highest disease burden is reported in North America and Western Europe. Although the prognosis remains good for patients with are diagnosed with early stage EC, for those with recurrent or metastatic disease, the options are few, and the median overall survival is short. It is imperative to gain a greater understanding of all aspects of EC, limit its effect on scarce health care resources and, more importantly, prevent this cancer from significantly impacting future generations of women. An exciting new era of endometrial cancer research and clinical management has begun that incorporates biologically and clinically relevant genomic and clinicopathologic parameters. Continued collaborative research efforts and funding are essential if we are to advance our understanding of this disease and improve clinical outcomes. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2787-2798. © 2016 American Cancer Society.

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The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—An institutional study and systematic review of the literature

Cited by 128 publications

References 30 publications

Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia

Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia

The Feasibility of Laparoscopic Surgery in Gynecologic Oncology for Obese and Morbidly Obese Patients

Endometrial cancer: Not your grandmother's cancer

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