open access

Vol 91, No 10 (2020)
Research paper
Published online: 2020-10-15
Get Citation

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

Slawomir M. Januszek, Edyta Barnas, Joanna Skret-Magierlo, Jakub Sokolowski, Pawel Szczerba, Rafal Januszek, Wojciech Domka, Krzysztof Piotr Malinowski, Katarzyna Kalandyk-Osinko, Marek Kluza, Aleksandra Bolanowska, Tomasz Kluz
DOI: 10.5603/GP.a2020.0099
·
Pubmed: 33184824
·
Ginekol Pol 2020;91(10):573-581.

open access

Vol 91, No 10 (2020)
ORIGINAL PAPERS Gynecology
Published online: 2020-10-15

Abstract

Objectives: Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity. Material and methods: The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes. Results: Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1–G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083–0.892, p = 0.018). Conclusions: The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss.

Abstract

Objectives: Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity. Material and methods: The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes. Results: Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1–G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083–0.892, p = 0.018). Conclusions: The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss.

Get Citation

Keywords

obesity; endometrial cancer; risk factors; minimally invasive therapy; sentinel lymph node procedure; total laparoscopic histerectomy; perioperative outcomes

About this article
Title

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

Journal

Ginekologia Polska

Issue

Vol 91, No 10 (2020)

Article type

Research paper

Pages

573-581

Published online

2020-10-15

DOI

10.5603/GP.a2020.0099

Pubmed

33184824

Bibliographic record

Ginekol Pol 2020;91(10):573-581.

Keywords

obesity
endometrial cancer
risk factors
minimally invasive therapy
sentinel lymph node procedure
total laparoscopic histerectomy
perioperative outcomes

Authors

Slawomir M. Januszek
Edyta Barnas
Joanna Skret-Magierlo
Jakub Sokolowski
Pawel Szczerba
Rafal Januszek
Wojciech Domka
Krzysztof Piotr Malinowski
Katarzyna Kalandyk-Osinko
Marek Kluza
Aleksandra Bolanowska
Tomasz Kluz

References (33)
  1. Lortet-Tieulent J, Ferlay J, Bray F, et al. International Patterns and Trends in Endometrial Cancer Incidence, 1978-2013. J Natl Cancer Inst. 2018; 110(4): 354–361.
  2. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12): 2893–2917.
  3. Finucane M, Stevens G, Cowan M, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. The Lancet. 2011; 377(9765): 557–567.
  4. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008; 371(9612): 569–578.
  5. von Gruenigen VE, Tian C, Frasure H, et al. Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma : a Gynecologic Oncology Group study. Cancer. 2006; 107(12): 2786–2791.
  6. van Wijk FH, van der Burg MEL, Burger CW, et al. [Surgical treatment for endometrial adenocarcinoma: first approaches. Review of the literature]. Gynecol Obstet Fertil. 2003; 31(5): 456–464.
  7. Obermair A, Manolitsas TP, Leung Y, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. Int J Gynecol Cancer. 2005; 15(2): 319–324.
  8. Holub Z, Bartös P, Jabor A, et al. Laparoscopic surgery in obese women with endometrial cancer. J Am Assoc Gynecol Laparosc. 2000; 7(1): 83–88.
  9. Kuoppala T, Tomás E, Heinonen PK. Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer. Arch Gynecol Obstet. 2004; 270(1): 25–30.
  10. Yu CKH, Cutner A, Mould T, et al. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women. BJOG. 2005; 112(1): 115–117.
  11. Papathemelis T, Oppermann H, Grafl S, et al. Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure. J Cancer Res Clin Oncol. 2020; 146(4): 961–969.
  12. National Comprehensive Cancer Network(NCCN)-Clinical practice guidelines: Uterus Neoplasm/ ENDO-C 2 of 6. https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (1.03.2020).
  13. Sznurkowski J, Knapp P, Bodnar L, et al. Recommendations of the Polish Gynecological Oncology Society for the diagnosis andtreatment of endometrial cancer. Current Gynecologic Oncology. 2017; 15(1): 34–44.
  14. Daraï E, Dubernard G, Bats AS, et al. Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol. 2015; 136(1): 54–59.
  15. Zullo F, Palomba S, Russo T, et al. A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: a focus on the quality of life. Am J Obstet Gynecol. 2005; 193(4): 1344–1352.
  16. Pellegrino A, Villa A, Fruscio R, et al. Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer. Arch Gynecol Obstet. 2009; 279(5): 655–660.
  17. Malinowski A, Pogoda K. [Total laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy of cervical cancer stage IB--case report]. Ginekol Pol. 2012; 83(2): 136–140.
  18. Malinowski A, Majchrzak-Baczmańska D, Pogoda K, et al. Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers. Ginekol Pol. 2013; 84(3): 197–205.
  19. Bijen CB, Vermeulen KM, Mourits MJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010; 11(8): 763–771.
  20. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009; 27(32): 5331–5336.
  21. Scaletta G, Dinoi G, Capozzi V, et al. Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review. Eur J Surg Oncol. 2020; 46(5): 782–788.
  22. Pelosi MA, Pelosi MA. Alignment of the umbilical axis: an effective maneuver for laparoscopic entry in the obese patient. Obstet Gynecol. 1998; 92(5): 869–872.
  23. Hurd WW, Bude RO, DeLancey JO, et al. The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique. Obstet Gynecol. 1992; 80(1): 48–51.
  24. Ahmad G, Baker J, Finnerty J, et al. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2019; 1: CD006583.
  25. Vellinga TT, De Alwis S, Suzuki Y, et al. Laparoscopic entry: the modified alwis method and more. Rev Obstet Gynecol. 2009; 2(3): 193–198.
  26. Thepsuwan J, Huang KG, Wilamarta M, et al. Principles of safe abdominal entry in laparoscopic gynecologic surgery. Gynecology and Minimally Invasive Therapy. 2013; 2(4): 105–109.
  27. Varghese A, Peijnenburg E, Stone RL, et al. Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery: Repurposing the left upper quadrant approach. Eur J Obstet Gynecol Reprod Biol. 2020; 244: 56–59.
  28. Janda M, Gebski V, Brand A, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol. 2010; 11: 772–780.
  29. Orekoya O, Samson ME, Trivedi T, et al. The Impact of Obesity on Surgical Outcome in Endometrial Cancer Patients: A Systematic Review. J Gynecol Surg. 2016; 32(3): 149–157.
  30. Santoso JT, Barton G, Riedley-Malone S, et al. Obesity and perioperative outcomes in endometrial cancer surgery. Arch Gynecol Obstet. 2012; 285(4): 1139–1144.
  31. Papathemelis T, Oppermann H, Grafl S, et al. Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure. J Cancer Res Clin Oncol. 2020; 146(4): 961–969.
  32. National Comprehensive Cancer Network(NCCN)-Clinical practice guidelines: Uterus Neoplasm/ENDO-C 2 of 6. https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (25.04.2020).
  33. Abdelazim IA, Abu-Faza M, Zhurabekova G, et al. Sentinel Lymph Nodes in Endometrial Cancer Update 2018. Gynecol Minim Invasive Ther. 2019; 8(3): 94–100.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl