Vaginal Hysterectomy for the Treatment of Endometrial Cancer and Endometrial Intraepithelial Hyperplasia in Superobese Patients

Abstract

Objective:

Given the increasing prevalence of obesity, the incidence of endometrial cancer and endometrial intraepithelial neoplasia (EIN) could increase twofold within the next 2 decades. Although hysterectomy is the preferred treatment, increasing body mass indices (BMIs) pose technical challenges to surgeons and are associated with adverse surgical outcomes. This study evaluated perioperative outcomes of superobese (BMI of ≥50 kg/m²) patients who underwent total vaginal hysterectomy (TVH), compared to total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH) for endometrial cancer or EIN.

Materials and Methods:

This was a retrospective cohort study of 84 patients with BMIs ≥50 kg/m² who underwent hysterectomy for treatment of endometrial cancer or EIN from July 1, 2007, to May 1, 2017, at a tertiary academic medical center. Demographic data, intraoperative parameters, and postoperative data were collected via a retrospective chart review. The primary outcome was a composite of intraoperative injury, Clavien–Dindo post-operative morbidity score, 30-day readmission rate, estimated blood loss >1000 cc, and transfusion. The secondary outcome was survival.

Results:

There was no difference in the combined perioperative primary outcome or survival for patients with BMIs ≥50 kg/m² undergoing TVH for EIN or endometrial cancer, compared to patients undergoing TAH or TLH.

Conclusions:

TVH is a viable surgical route for superobese patients with endometrial cancer or EIN. Further evaluation of the role of TVH in the setting of EIN and endometrial cancer is needed as the superobese population rapidly increases. (J GYNECOL SURG 37:470)