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Early endometrial carcinoma therapy in morbid obesity: A retrospective study comparing open and laparoscopic. Int J Surg 2016; 30:31-4. [PMID: 27102329 DOI: 10.1016/j.ijsu.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/27/2016] [Accepted: 04/08/2016] [Indexed: 11/21/2022]
Abstract
OBJECT The present study sought to explore the therapeutic outcome of laparoscopic surgery for the endometrial cancer patients with morbidly obese in china. METHODS The morbidly obese patients with clinical stage I or II endometrial cancer received laparoscopic surgery (LS) at the Obstetrics and Gynecology centers of PLA general hospital between November 2012 and November 2014. The clinical outcomes of these surgeries were compared with a historical cohort of similar morbidly obese patients who had received the open surgery (OS). In the present study, the morbidly obesity was defined as the body mass index was bigger than 40 kg/m(2). The basic characteristics of the involved patients, the therapeutic effects of the surgery, as well as the incidence of perioperative complications were systematically compared between the two groups. RESULTS Totally 120 patients were included in the present study (respectively 60 patients in the LS group and the OS group). There was no statistical difference between the LS group and the OS group in terms of patient age or BMI. However, the incidence of intraoperative complication in the LS group was significantly lower than that in the OS group (5.0% vs. 16.7%; P = 0.04. Moreover, the incidence of postoperative complication in the OS group was higher than that in the LS group (20.0% vs.6.7%; P = 0.03). The length of hospital stay in the LS group was longer than that in the OS group (6 vs.11 days; P = 0.02). Furthermore, the rates of (pelvic) lymph node dissection and para-aortic node dissection in the LS group were not significantly different from the OS group. CONCLUSION LS is verified to be a safe and rational therapeutic strategy for the endometrial cancer patients with morbidly obese. The incidence of perioperative complications is significantly lower in comparison with the OS.
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Cote ML, Ruterbusch JJ, Ahmed Q, Bandyopadhyay S, Alosh B, Abdulfatah E, Seward S, Morris R, Ali-Fehmi R. Endometrial cancer in morbidly obese women: do racial disparities affect surgical or survival outcomes? Gynecol Oncol 2014; 133:38-42. [PMID: 24680590 DOI: 10.1016/j.ygyno.2014.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Endometrial cancer mortality disproportionately affects black women and whether greater prevalence of obesity plays a role in this disparity is unknown. We examine the effect of race on post-surgical complications, length of stay, and mortality specifically in a morbidly obese population. METHODS Black and white women with endometrial cancer diagnosed from 1996 to 2012 were identified from the University Pathology Group database in Detroit, Michigan, and records were retrospectively reviewed to obtain clinicopathological, demographic, and surgical information. Analysis was limited to those with a body mass index of 40kg/m(2) or greater. Differences in the distribution of variables by race were assessed by chi-squared tests and t-tests. Kaplan-Meier and Cox regression analyses were performed to examine factors associated with mortality. RESULTS 97 white and 89 black morbidly obese women were included in this analysis. Black women were more likely to have type II tumors (33.7% versus 15.5% of white women, p-value=0.003). Hypertension was more prevalent in black women (76.4% versus 58.8%, p-value=0.009), and they had longer hospital stays after surgery despite similar rates of open vs minimally invasive procedures and lymph node dissection (mean days=5.4) compared to whites (mean days=3.5, p-value=0.036). Wound infection was the most common complication (16.5% in whites and 14.4% in blacks, p-value=0.888). Blacks were more likely to suffer other complications, but overall the proportions did not differ by race. In univariate analyses, black women had higher risk of endometrial cancer-related death (p-value=0.090). No racial differences were noted in adjusted survival analyses. CONCLUSION A more complete investigation, incorporating socio-demographic factors, is warranted to understand the effects of morbid obesity and race on endometrial cancer.
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Affiliation(s)
- M L Cote
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Program, Detroit, MI, USA.
| | - J J Ruterbusch
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA
| | - Q Ahmed
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | - S Bandyopadhyay
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | - B Alosh
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | - E Abdulfatah
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | - S Seward
- Wayne State University School of Medicine, Department of Gynecologic Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, MI, USA
| | - R Morris
- Wayne State University School of Medicine, Department of Gynecologic Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, MI, USA
| | - R Ali-Fehmi
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
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Greimel E, Nordin AJ. Application of quality-of-life measurements in clinical trials and in clinical practice for gynecologic cancer patients. Expert Rev Pharmacoecon Outcomes Res 2014; 10:63-71. [DOI: 10.1586/erp.09.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Khavanin N, Mlodinow A, Milad MP, Bilimoria KY, Kim JY. Comparison of Perioperative Outcomes in Outpatient and Inpatient Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2013; 20:604-10. [DOI: 10.1016/j.jmig.2013.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 10/26/2022]
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Helm CW, Arumugam C, Gordinier ME, Metzinger DS, Pan J, Rai SN. Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications. J Gynecol Oncol 2011; 22:168-76. [PMID: 21998759 PMCID: PMC3188715 DOI: 10.3802/jgo.2011.22.3.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/07/2011] [Accepted: 05/01/2011] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ≥3 complications 9.2:34.0 (p<0.01), ≥3 wound complications 3.1:22.3 (p<0.01) and ≥3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (≥36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.
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Affiliation(s)
- C William Helm
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, St. Louis University School of Medicine, St. Louis, MO, USA
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Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M, Bolis P. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol 2011; 205:119.e1-12. [PMID: 21620360 DOI: 10.1016/j.ajog.2011.03.024] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/07/2011] [Accepted: 03/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy. STUDY DESIGN We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used. RESULTS In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6). CONCLUSION Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.
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Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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Al-talib A, Sheizaf B, Almog B, Dawood A, Krishnamurthy S, Tulandi T. Morbidity with total laparoscopic and laparoscopically assisted vaginal hysterectomy. Acta Obstet Gynecol Scand 2011; 90:284-7. [PMID: 21306312 DOI: 10.1111/j.1600-0412.2010.01047.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the operative and postoperative morbidity among 103 women who underwent total laparoscopic hysterectomy and 107 others who underwent laparoscopically assisted vaginal hysterectomy. Blood loss was significantly greater in the assisted vaginal hysterectomy group (178.0 ± 12.1 ml) than in the total hysterectomy group (130.2 ± 10.7 ml) (p < 0.001). Despite higher uterine weight in the total hysterectomy group, the operative time of both techniques was similar. The complications of both hysterectomies were also comparable. The results from our study suggest that the complication rates of laparoscopically assisted vaginal hysterectomy and total hysterectomy are similar. However, laparoscopically assisted vaginal hysterectomy is associated with increased blood loss.
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Affiliation(s)
- Ayman Al-talib
- Department of Obstetrics and Gynecology, University of Dammam, Saudi Arabia
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O’Hanlan KA, McCutcheon SP, McCutcheon JG. Laparoscopic Hysterectomy: Impact of Uterine Size. J Minim Invasive Gynecol 2011; 18:85-91. [DOI: 10.1016/j.jmig.2010.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/25/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
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The laparoscopic-assisted vaginal approach to early endometrial cancer. Arch Gynecol Obstet 2010; 282:177-83. [PMID: 20309570 DOI: 10.1007/s00404-010-1416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION For the surgical treatment of endometrial cancer laparotomy still is regarded as the gold standard. Over the past decade, the laparoscopic approach has gained equivalence in FIGO stage I carcinomas. RESULTS Laparoscopic-assisted vaginal hysterectomy and bilateral salpingooophorectomy plus pelvic/paraaortic lymphadenectomy have shown short-term advantages such as reduced blood loss and shorter hospitalization without reducing oncological safety or outcome. This has already been confirmed by numerous smaller studies and recent randomized controlled trials with sufficient numbers of patients are being published. CONCLUSION Further acceptance of the technique is necessary to enable every gynecological oncologist to individualize treatment by offering minimal access options.
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Fader AN, Arriba LN, Frasure HE, von Gruenigen VE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 2009; 114:121-7. [PMID: 19406460 DOI: 10.1016/j.ygyno.2009.03.039] [Citation(s) in RCA: 242] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 03/20/2009] [Accepted: 03/29/2009] [Indexed: 01/03/2023]
Abstract
Endometrial cancer is the most common gynecologic malignancy in the Western world and is strongly associated with obesity. Despite the fact that most cases are diagnosed in early, more favorable stages, endometrial cancer incidence and mortality rates are on the rise. Morbidly obese women with endometrial cancer are more likely to die of their co-morbidities and also of their cancers when compared to their leaner cohorts. Given the increasing rates of morbid obesity in the United States, it is essential to develop appropriate screening tools and guidelines to reduce cancer morbidity and death amongst this group. Through an analysis of the existing literature, we present a review of the epidemiologic trends in obesity and endometrial cancer, discuss the promising role of screening biomarker studies, review prevention efforts and modifiable risk factors, and ways in which health outcomes and quality of life for endometrial cancer survivors may be optimized.
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Affiliation(s)
- Amanda Nickles Fader
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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