Impact of obesity on surgical and pathological outcomes in women with endometrial cancer undergoing robotic-assisted surgical staging

Abstract

One of every three women in the United States is obese. Obesity is a well-known risk factor for the development of EC, and is associated with up to 46% of all cases. Endometrial cancer (EC) is the most common gynecologic cancer. The aim of this study was to evaluate the effect of obesity on patients undergoing robotic-assisted (RA) laparoscopic surgical staging for endometrial cancer. This is a multi-institutional retrospective cohort study of patients undergoing RA surgical management of EC. All patients underwent comprehensive surgical staging including hysterectomy, bilaterally salpingoophorectomy, pelvic lymphadenectomy and when feasible paraaortic lymphadenectomy. Surgical and pathologic outcomes of obese (BMI ≥30) versus non-obese women (BMI <30) were compared. From 2013-2017, 103 patients were identified. 67 were obese and the remaining 36 were non-obese. There was no significant statistical difference in total operative time, FIGO grade or depth of myometrial invasion between the obese and non-obese cohort. We observed an increase in EBL in the obese vs non-obese cohorts (p 0.007). Additionally, we observed an increase incidence of adverse events in the obese patient cohort, complicating 10.45% (7/67) of cases, compared to the non-obese cohort 5.56% (2/36). Of these complications, only the obese patient cohort suffered from intraoperative complications (3/67), including thermal injury, arrhythmia and airway management problem. There were no intraoperative adverse events in the non-obese cohort. Obese patients were more likely to have a final pathologic diagnosis of endometriod adenocarcinoma (89%) versus those in the non-obese cohort (75%). In conclusion, obese patients undergoing RA surgical management of EC is associated with a significant increase in EBL in obese compared with non-obese patients. Obesity appears to confer and increase risk of intraoperative and postoperative complications. Obese women are more likely to be diagnosed with endometriod adenocarcinoma on final pathology.