Background: Obesity is a significant public health problem in the United States, and many studies have established obesity as a significant risk factor for endometrial cancer. Surgery is the standard of care in staging and treatment of endometrial cancer, and obesity may influence surgical outcomes because of its attendant comorbid conditions. Therefore, assessment of the impact of obesity on surgical outcome is important for decreasing morbidity and improving survival in patients with endometrial cancer. Objective: The aims of this research were to evaluate and review epidemiologic data systematically on the impact of obesity on surgical outcomes and to assess safety and feasibility of newer surgical techniques in obese patients. Materials and Methods: A systematic search of PubMed was conducted to identify articles between 2004 and 2013 that focused on the impact of obesity on surgical outcome. Reference lists of retrieved articles were also used to identify other relevant articles. Thirteen relevant articles were reviewed. Results: Evidence from epidemiologic studies showed that obesity impacts surgical outcome adversely. On average, obese patients have worse surgical outcomes than their nonobese counterparts. In addition, surgical outcome worsens as level of obesity increases. However, surgical procedure also influences this association. Minimally invasive surgeries are more useful and are accompanied with fewer complications than conventional laparotomy and can be performed safely in obese patients. Conclusions: Obesity is a significant risk in the etiology, treatment, and surgical outcomes of patients with endometrial cancer. Future research will need more randomized controlled trials and prospective studies to identify the best procedures for maximal outcomes. (J GYNECOL SURG 32:149)
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References
1.
SiegelR, NaishadhamD, JemalA. Cancer statistics, 2013. CA Cancer J Clin, 2013; 63:11.
2.
BergströmA, PisaniP, TenetV, WolkA, AdamiHO. Overweight as an avoidable cause of cancer in Europe. Int J Cancer, 2001; 91:421.
3.
FambriniM, PieralliA, BitossiU, et al.Mini-laparotomy versus vaginal surgery for class II–III obese patients with early-stage endometrial cancer. Anticancer Res, 2012; 32:707.
4.
AkbayırO, Corbacıoglu EsmerA, NumanogluC, Cılesız GoksedefBP, AkcaA, BakırLV, KuruO. Influence of body mass index on clinicopathologic features, surgical morbidity and outcome in patients with endometrial cancer. Arch Gynecol Obstet, 2012; 286:1269.
5.
EverettE, TamimiH, GreerB, SwisherE, PaleyP, MandelL, GoffB. The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol, 2003; 90:150.
6.
LinkovF, EdwardsR, BalkJ, YurkovetskyZ, StadtermanB, LokshinA, TaioliE. Endometrial hyperplasia, endometrial cancer and prevention: Gaps in existing research of modifiable risk factors. Eur J Cancer, 2008; 44:1632.
7.
RabischongB, LarrainD, CanisM, et al.Long-term follow-up after laparoscopic management of endometrial cancer in the obese: A fifteen-year cohort study. J Minim Invasive Gynecol, 2011; 18:589.
8.
PapadiaA, RagniN, SalomEM. The impact of obesity on surgery in gynecological oncology: A review. Int J Gynecol Cancer, 2006; 16:944.
9.
ZhangY, LiuZ, YuX, ZhangX, LüS, ChenX, LüB. The association between metabolic abnormality and endometrial cancer: A large case-control study in China. Gynecol Oncol, 2010; 117:41.
10.
KaaksR, LukanovaA, KurzerMS. Obesity, endogenous hormones, and endometrial cancer risk: A synthetic review. Cancer Epidemiol Biomarkers Prev, 2002; 11:1531.
11.
OgdenCL, CarrollMD, KitBK, FlegalKM. Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief, 2012; 82:1.
12.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—the Evidence Report: National Institutes of Health. Obes Res, 1998; 6(suppl2):51S;erratum in Obes Res, 1998; 6:464.
13.
BlewRM, SardinhaLB, MillikenLA, et al.Assessing the validity of body mass index standards in early postmenopausal women. Obes Res, 2002; 10:799.
14.
OkoroduduDO, JumeanMF, MontoriVM, Romero-CorralA, SomersVK, ErwinPJ, Lopez-JimenezF. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: A systematic review and meta-analysis. Int J Obes (Lond), 2010; 34:791.
15.
SantiA, KuhnA, GyrT, EberhardM, JohannS, GünthertAR, MuellerMD. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage endometrial cancer. Surg Endosc, 2010; 24:939.
16.
AmantF, MoermanP, NevenP, TimmermanD, Van LimbergenE, VergoteI. Treatment modalities in endometrial cancer. Curr Opin Oncol, 2007; 19:479.
17.
PressJZ, GotliebWH. Controversies in the treatment of early stage endometrial carcinoma. Obstet Gynecol Int, 2012; 2012:578490.
18.
AcholonuUCJr., Chang-JacksonSC, RadjabiAR, NezhatFR. Laparoscopy for the management of early-stage endometrial cancer: From experimental to standard of care. J Minim Invasive Gynecol, 2012; 19:434.
19.
American Association of Gynecologic Laparoscopists (AAGL). AAGL position statement: Route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol, 2011; 18:1.
20.
KueckAS, GossnerG, BurkeWM, ReynoldsRK. Laparoscopic technology for the treatment of endometrial cancer. Int J Gynaecol Obstet, 2006; 93:176.
21.
ModesittSC, van NagellJRJr.The impact of obesity on the incidence and treatment of gynecologic cancers: A review. Obstet Gynecol Surv, 2005; 60:683.
22.
ObermairA, ManolitsasTP, LeungY, HammondIG, McCartneyAJ. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. Int J Gynecol Cancer, 2005; 15:319.
23.
GiugaleLE, Di SantoN, SmolkinME, HavrileskyLJ, ModesittSC. Beyond mere obesity: Effect of increasing obesity classifications on hysterectomy outcomes for uterine cancer/hyperplasia. Gynecol Oncol, 2012; 127:326.
24.
PavelkaJC, Ben-ShacharI, FowlerJM, et al.Morbid obesity and endometrial cancer: Surgical, clinical, and pathologic outcomes in surgically managed patients. Gynecol Oncol, 2004; 95:588.
25.
SubramaniamA, KimKH, BryantSA, et al.A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma. Gynecol Oncol, 2011; 122:604.
26.
EisenhauerEL, WypychKA, MehraraBJ, LawsonC, ChiDS, BarakatRR, Abu-RustumNR. Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy. Ann Surg Oncol, 2007; 14:2384.
27.
ErkanliS1, KayaselçukF, BagisT, KuşçuE. Impact of morbid obesity in surgical management of endometrial cancer: Surgical morbidity, clinical and pathological aspects. Eur J Gynaecol Oncol, 2006; 27:401.
28.
SantosoJT, BartonG, Riedley-MaloneS, WanJY. Obesity and perioperative outcomes in endometrial cancer surgery. Arch Gynecol Obstet, 2012; 285:1139.
29.
BernardiniMQ, GienLT, TippingH, MurphyJ, RosenBP. Surgical outcome of robotic surgery in morbidly obese patient [sic] with endometrial cancer compared to laparotomy. Int J Gynecol Cancer, 2012; 22:76.
30.
LauS, BuzagloK, VakninZ, et al.Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer. Int J Gynecol Cancer, 2011; 21:722.
31.
AremH, IrwinML, ZhouY, LuL, RischH, YuH. Physical activity and endometrial cancer in a population-based case-control study. Cancer Causes Control, 2011; 22:219.
32.
GierachGL, ChangSC, BrintonLA, LaceyJVJr, HollenbeckAR, SchatzkinA, LeitzmannMF. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer, 2009; 124:2139.
33.
MooreSC, GierachGL, SchatzkinA, MatthewsCE. Physical activity, sedentary behaviours, and the prevention of endometrial cancer. Br J Cancer, 2010; 103:933.
