Mini-laparotomy versus Vaginal Surgery for Class II-III Obese Patients with Early-stage Endometrial Cancer

Aim: To compare minilaparotomic and vaginal surgery in selected obese patients with early-stage endometrial cancer at high surgical risk. Patients and Methods: Data of 37 consecutive class II-III obese patients submitted to minilaparotomic surgery were retrospectively reviewed. Thirty-seven women matched for demographic characteristics, BMI and stage of disease submitted to vaginal surgery in the same period comprised the control group. Results: No difference was observed concerning intra- and postoperative data among the two groups. The patients who were submitted to general anesthesia exhibited a larger use of supplemental drugs for pain control (p>0.01), a higher incidence of thromboembolic events (p>0.005) and a longer hospitalization (p>0.02). No statistical difference was observed in terms of pattern of recurrence, disease-free survival and overall survival between the two groups of patients. Conclusion: Obese patients with endometrial cancer unfit for vaginal surgery can be safely managed through mini-laparotomy with the same surgical and oncological outcomes. The association between obesity and endometrial cancer (EC) is well established. Epidemiologic data has shown a two to five fold increased risk of developing EC in obese premenopausal and postmenopausal women and obesity has been associated with at least 40% of the incidence of EC (1- 3). Mortality from uterine cancer also seems to increase with body mass index (BMI). A prospective study through the American Cancer Society following 495,477 women found that those with a BMI >40 had an increased relative risk (RR) of mortality from EC of 6.25 (4). Traditionally surgical staging for women with EC has been performed through longitudinal laparotomy. However, with traditional surgery, obese patients are thought to be at higher risk of postoperative complications and longer hospitalization. Many authors in recent literature report on favorable results with endoscopic surgery among obese patients (5, 6). However, obese women with EC frequently have coexisting morbidities, such as diabetes mellitus and cardiovascular and pulmonary diseases. In such patients, comprehensive surgical staging through laparoscopy or robotic surgery is sometimes precluded by their poor medical condition which contraindicates long time of surgery, prolonged Trendelemburg position and general anesthesia.