Presurgical assessment of intraabdominal visceral fat in obese patients with early-stage endometrial cancer treated with laparoscopic approach: relationships with early laparotomic conversions.

摘要

STUDY OBJECTIVE: To evaluate the relationship between intraabdominal visceral fat (IVF) and early conversion from laparoscopy to laparotomy in obese patients. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Department of obstetrics and gynecology, University "Magna Graecia" of Catanzaro. PATIENTS: One hundred fifty-one obese patients with endometrial cancer and laparoscopic surgery. INTERVENTIONS: Laparoscopic treatment for early-stage endometrial cancer. MEASUREMENT AND MAIN RESULTS: In all patients, demographic, anthropometric (including body mass index, waist-to-hip ratio, and waist circumference), and IVF assessments (using ultrasonography [IVF-USG, cm] and computed tomography [IVF-CT, cm(2)]), were evaluated. In 122 patients (122/151, 80.8%), the laparoscopies were successfully completed (group A), whereas 29 patients (29/151, 19.2%) had a laparotomic conversion. Specifically, in 19 (19/29, 65.5%) and in 10 patients (10/29, 34.5%) the conversion was early (group B1) and late (group B2), respectively. A significant (p <.05) difference in surgical stage IC and in postoperative complications rate was detected between group A and groups B1 and B2, without difference between these 2 last groups. IVF-USG and IVF-CT were significantly (p <.01) higher in group B1 in comparison with groups A and B2, without difference between these 2 last groups. A strong and significant (p <.001) association between IVF-USG and IVF-CT was detected in all groups by Spearman bivariate correlation (r = 0.78, 0.918, and 0.978 for group A, B1, and B2, respectively). Multivariate analysis showed the IVF-CT as the main predictor for early laparotomic conversion (OR 2.184; 95% CI 1.227-3.886). CONCLUSIONS: Intraabdominal visceral fat is a predictor for early laparotomic conversion in obese patients with endometrial cancer. Further studies are necessary to assess the efficacy of the IVF evaluation for reducing the laparotomic conversion risk in obese women undergoing laparoscopic surgery for gynecologic malignancy.