Cáncer de endometrio en grandes obesas: tratamiento quirúrgico

Abstract

Objective To evaluate morbidity in distinct surgical approaches for the treatment of endometrial cancer in patients with a body mass index (BMI)⩾35(kg/m 2). Material and methods We performed a descriptive, retrospective study of 36 consecutive patients with a BMI >35 and endometrium cancer who underwent surgery from January 1996 to January 2007. The patients were classified into two groups according to whether the laparoscopic (LPS) or laparotomic (LPM) approach was used. The following factors were analyzed: age, BMI, previous surgery, risk factors, type of surgery, operating time, complications, mean length of hospital stay, conversion rate, transfusion rate, FIGO stage, histological type, and survival. Results The mean age was 64.40±1.28 (50–83) years and the mean BMI was 39.94±0.73(35.1–55.3) kg/m 2. A total of 8.3% (three patients) had previous abdominal surgery, 69.4% (25 patients) had endometrial risk factors and 8.3% (three patients) had received tamoxifen treatment. The initial surgical access was LPS in 16 patients (44.4%) and was LPM in the remaining 20 patients (55.5%). Lymphadenectomy was feasible in 55% of LPM and in 93.8% of LPS. Conversion to laparotomy was required in three patients (18.8%) due to anesthetic problems. The length of hospital stay and hemoglobin balance were more favorable in LPS (p<0.001). No differences were found in nodal extraction. The survival rate was similar with the two approaches (p=0.29). Conclusions High BMI should not be considered as a contraindication for LPS. Successful laparoscopic management and staging reduces hospital stay and morbidity.