Effect of pre-surgical body mass index on surgical safety after laparoscopic surgery for apparent early stage endometrial cancer — YRD
  1. Schedule
  2. Session 2
  3. Effect of pre-surgical body mass index on surgical safety after laparoscopic surgery for apparent early stage endometrial cancer

Effect of pre-surgical body mass index on surgical safety after laparoscopic surgery for apparent early stage endometrial cancer (2897)

Andreas Obermair 1 , Nigel R Armfield 1 , Val Gebski 2 , Alison Brand 3 , Russell Hogg 3 , Thomas W Jobling 4 , Russell Land 5 , Tom Manolitsas 4 , Marcelo Nascimento 5 , Deborah Neesham 6 , James L Nicklin 5 , Martin K Oehler 7 , Geoff Otton 8 , Lewis Perrin 5 , Stuart Salfinger 9 , Ian Hammond 10 , Yee Leung 11 , Peter Sykes 12 , Hextan Ngan 13 , Andrea Garrett 5 , Michael Laney 12 , Tong Yow Ng 13 , Kafari Tam 13 , Karen Chan 13 , David H Wrede 6 , Selvan Pather 14 , Bryony Simcock 12 , Rhonda Farrell 15 , Gregory Robertson 15 , Graeme Walker 16 , Monika Janda 17
  1. University of Qld, QCGC, Greenslopes, QLD, Australia
  2. University of Sydney NHMRC Clinical Trials Centre, Sydney
  3. Dept of Gynaecologic Oncology, Westmead Hospital, Sydney
  4. Dept of Gynaecologic Oncology, Monash Medical Centre, Melbourne
  5. Queensland Centre for Gynaecological cancer , Brisbane
  6. Royal Women's Hospital, Melbourne
  7. Royal Adelaide Hospital, Adelaide
  8. John Hunter Hospital, Newcastle
  9. King Edward Hospital, Perth, WA
  10. St John of God Hospital, Perth, WA
  11. School of Women's and Infants' Health, University of WA, Perth, WA
  12. Christchurch Women's Hospital, Christchurch, New Zealand
  13. Dept of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
  14. Royal Prince Alfred Hospital, Sydney, NSW
  15. Royal Hospital for Women, Sydney, NSW
  16. Royal Infirmary of Edinburgh, Scotland
  17. School of Public Health, Institute of Health and Biomedical Innovation, QUT, Brisbane, QLD

Objective: To compare surgical safety and quality of life (QoL) among women with a lower (<30) versus higher (>=30) body mass index (BMI), who received a total laparoscopic hysterectomy (TLH) for apparent early stage endometrial cancer.

Methods: Between October 2005 and June 2010, 760 women were enrolled in a multi-centre, randomized clinical trial (LACE) comparing outcomes following TLH or total abdominal hysterectomy. Here we use data from the TLH arm only (n=404), and compare adverse events (AE), hospital length of stay (LoS), conversion from laparoscopy to laparotomy, and QoL measured by EQ-5D. Postoperative AEs were graded according to Common Toxicity Criteria (CTC) v3, and those grade >=3 are reported here.

Results: While there was no difference in intraoperative AEs, or post-operative LoS between the two groups, the relative risk of at least one post-operative AE CTC Grade 3+ was significantly higher for women with BMI>=30, compared to leaner women (BMI 30>= 15.6% vs BMI<30 6.2%; RR = 2.49, 95% CI 1.24 – 5.0, p=0.01). Mean operating time was on average 9 minutes longer for women with BMI 30>= (95% CI 1.0 – 17.3, p=0.03). Of the 21 women who required a conversion from TLH to TAH, 16 (76%) had a BMI of >=30. At four weeks post-surgery a significantly greater proportion of women in the higher BMI group still reported problems with mobility (4.8%) and self-care (22.2%; p<0.05) compared to patients with in the lower BMI group (0% and 12.8%, respectively; p<0.05). Long term quality of life did not differ significantly between groups.

Conclusions: Compared to patients with a BMI of <30, women with higher BMI who present for hysterectomy have a significantly greater risk of post-operative adverse events, even if they are treated with minimally invasive surgery. These data can be used to inform patients about their increased risk.  In addition, non-surgical treatment alternatives need to be investigated for patients at greatly increased surgical risk.

This work is conducted in dedication to the late Anthony McCartney