Surgical Approaches and Short-Term Surgical Outcomes for Patients with Morbid Obesity and Endometrial Cancer

摘要

Introduction: Due to the increasing incidence of obesity, we wanted to evaluate the short-term outcomes of obese women undergoing open abdominal surgery for endometrial cancer in regard to staging capability and postoperative morbidity. This report also describes the use of new surgical approaches to improve surgical exposure in these patients. Materials and Methods: Patients undergoing primary surgery for uterine cancer with a body mass index (BMI) ≥40 between June 2000 and July 2007 were retrospectively identified from tumor registry databases. Data collected included type of surgical incision, estimated blood loss (EBL), length of stay (LOS), and postoperative complications associated with the incision. Results: Seventy-two (72) patients were included in the study, with a mean BMI of 47.2kg/m2. Fifty-nine (59) patients had a midline or transverse laparotomy incision; these patients had a mean BMI of 45.6kg/m2, mean EBL of 547mL, and LOS of 3.7 days. Thirteen (13) patients underwent a surgical incision, utilizing pannus mobilizing techniques. The average BMI was 54.2kg/m2, EBL 365mL, and LOS 3.5 days in this patient group. Fourteen (14) events of wound-related postoperative morbidity occurred, with 20.3% occurring in patients with standard incisions and 15.4% with modified incisions. Conclusions: Patients undergoing surgery for endometrial cancer with a BMI ≥40kg/m2 experienced wound-related postoperative morbidity in 19.4% of cases. Modifications to the incisional approach may provide improved surgical exposure with an acceptable wound-complication rate. (J GYNECOL SURG 25:41)