Abstract
BackgroundMany women who develop endometrial cancer (EC) or endometrial hyperplasia with atypia are obese and therefore at high risk of surgical complications. Recently clinical trials have been initiated offering non-surgical treatment to these women, but not all may agree to participate in such trials. This paper aims to describe the patient characteristics, and surgical outcomes of women with suspected early stage endometrial cancer and body mass index (BMI) of 30 or greater, who declined enrolment in the feMMe trial, which offers non-surgical hormonal treatment, hormonal plus metformin or hormonal plus weight loss as primary treatment.MethodsConsecutive case series from a tertiary gynaecological oncology unit. Over the course of the first 2 years of the feMMe trial, 27 patients met the initial eligibility screening, but declined enrolment in the feMMe trial and opted for upfront surgery. The main surgical outcome measures were type of surgical approach, need for conversion from laparoscopic to open approach, length of stay in hospital and adverse events.ResultsPatients’ median age was 63 years (range 40 to 86); median BMI was 37.3 kg/m2 (range 30.7 to 54.7); median medical co-morbidities were six (range 3–10). Of the 26/27 surgeries planned to be undertaken laparoscopically, 2/26 patients had to be converted (7 %). Overall, the average hospital stay was 4.5 days, and 11/27 (41 %) of the patients developed one or more adverse events grade 2+ rated according to the Common Toxicity Criteria Version 3.ConclusionsAdverse surgical outcomes are common in multi-morbid, obese or morbidly obese patients diagnosed with early stage EC or endometrial hyperplasia with atypia and who have a hysterectomy.
Highlights
Many women who develop endometrial cancer (EC) or endometrial hyperplasia with atypia are obese and at high risk of surgical complications
Main findings Adverse surgical outcomes are common in multi-morbid and morbidly obese patients diagnosed with early stage EC who have a hysterectomy
The LACE trial compared open with laparoscopic surgery for early stage EC or endometrial hyperplasia with atypia
Summary
Many women who develop endometrial cancer (EC) or endometrial hyperplasia with atypia are obese and at high risk of surgical complications. Obesity is associated with increased risk of medical co-morbidities (e.g., diabetes, cardiovascular) [6,7,8]; the need for intense preoperative assessments; While surgical treatment of EC is generally effective, it does not address the specific needs of the steadily growing group of morbidly obese and multi-morbid patients as well as young obese patients still desiring fertility [16, 17] For these growing groups of patients treatment often comes at a high personal cost (long hospital stay, protracted recovery from surgery, high incidence of postoperative complications) and subsequent high healthcare cost. The search for treatment alternatives that are safe, effective and less harmful than surgery is warranted
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