The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—An institutional study and systematic review of the literature

• Obesity increases risk of postoperative complications in endometrial cancer.
• Laparoscopic surgery reduces postoperative complications in obese women.
• Prehabilitation may be a means to further reduce surgical morbidity.

ObjectivesWe aimed to evaluate the association between body mass index (BMI), perioperative complications and outcomes in endometrial cancer (EC) patients at our institution. In addition, we performed a systematic review to compare our results to the literature.MethodsThis was a retrospective study of surgically managed EC patients between January 2006 and January 2015. Patient characteristics, surgical complications and intra- and postoperative outcomes were evaluated across BMI groups; BMI < 30 kg/m2, BMI ≥ 30 kg/m2 and BMI ≥ 40 kg/m2. The systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.ResultsIn total, we identified 627 women of which 514 were included; 249 women had a BMI of < 30 kg/m2, 195 women had a BMI of 30–39.9 kg/m2, and 70 women were morbidly obese (BMI ≥ 40 kg/m2). Obese women (BMI ≥ 30 kg/m2) had significantly more postoperative surgical complications, including wound complications and antibiotics use, which was confirmed by the systematic review. The increase in complications mainly occurred in open surgery and morbidly obese patients were at highest risk. Obesity did not impact other outcomes including 30-day mortality.ConclusionObesity is associated with an increased risk of surgical morbidity in EC patients, and is most profound in open surgery and among the morbidly obese. Laparoscopic surgery may well prevent the majority of postoperative complications in this group of patients, and should therefore be the favoured approach.