Defining and mitigating the challenges of an older and obese population in minimally invasive gynecologic cancer surgery

Hagemann, Andrea R.; McCourt, Carolyn K.; Varaday, S.; Moore, Kathleen N.

doi:10.1016/j.ygyno.2017.12.020

Cited by 11 publications

(9 citation statements)

References 73 publications

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“…In terms of pulmonary complications, obese patients have a higher incidence of sleep apnea, which may increase risk of intubation due to difficult airway and anesthesia care 33 . Increased abdominal pressure in obese patients, combined with the required pneumoperitoneum and Trendelenburg positioning in minimally invasive hysterectomy, may also decrease lung capacity and increase systemic vascular resistance, leading to poorer oxygenation and risk of barotrauma with ventilation 33,34 . Increased subcutaneous tissue depth in obese patients may also lead to poorer wound healing and higher rates of surgical site complications 35 .…”

Section: Discussionmentioning

confidence: 99%

“…Increased subcutaneous tissue depth in obese patients may also lead to poorer wound healing and higher rates of surgical site complications 35 . Surgery and exposure may also be more technically difficult in obese patients, leading to longer operative times and greater duration of anesthesia 33,34 . Indirectly, obesity‐related medical comorbidities instead of obesity itself may be responsible for much of the increased morbidity in these patients 33,36 …”

Section: Discussionmentioning

confidence: 99%

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National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Matsuo

Mandelbaum

Nusbaum

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. Material and methods This is a population‐based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509 395 women who underwent hysterectomy for benign gynecological disease: 430 865 (84.6%) non‐obese women, 50 435 (9.9%) women with class I‐II obesity and 28 095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort‐level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient‐level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple‐group generalized boosted model. Results The rate of class III obesity increased by 40.4%, higher than the rate of class I‐II obesity (22.2%) (both, P < .001). In parallel, cohort‐level rates of perioperative complication and prolonged hospitalization for ≥7 days increased by 19.4% and 54%, respectively (P < .001). In a weighted model, class I‐II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08‐1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28‐1.51) had a significantly increased risk of perioperative complications compared with non‐obesity. Larger body habitus was associated with higher total charge (median, $35 180, $36 094 and $39 382; all values cited in US dollars) and prolonged admission rate for ≥7 days (2.9%, 3.1% and 3.9%) (both, P < .001). Conclusions The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society‐based approaches are necessary to reduce the obesity rate and hysterectomy morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Matsuo

Mandelbaum

Nusbaum

et al. 2020

Acta Obstet Gynecol Scand

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“…As the number of people at a higher age is growing, there will be an increase in the number of elderly people needing surgery. Moreover, an increase in the number of cases of endometrial cancer is expected due to aging and increase in BMI in the population 22. Therefore, the beneficial effect of LH on QOL and the minimal impact of age on QOL after LH should be taken into account when considering surgical treatment for elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…A growing proportion of older women will have a malignant indication for hysterectomy, as with increasing age and body mass index (BMI) the incidence of endometrial cancer will increase 22. In early-stage low-risk endometrial cancer, several reviews report a better short-term QOL and faster recovery after LH compared to AH 5–10.…”

Section: Introductionmentioning

confidence: 99%

Age should not be a limiting factor in laparoscopic surgery: a prospective multicenter cohort study on quality of life after laparoscopic hysterectomy

Briët¹,

Mourits²,

Leeuwen³

et al. 2018

CIA

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PurposeA prospective, multicenter cohort study was performed on the implementation of laparoscopic hysterectomy (LH) in the Netherlands. The aim of this study was to evaluate the impact of LH on quality of life (QOL) with respect to age up to 6 months postoperatively.Patients and methodsWomen with an indication for LH, either for benign conditions or early-stage low-risk endometrial cancer were included. QOL was measured before and 6 weeks and 6 months after surgery, using the 36-item Short Form Health Survey. Mean QOL values were compared to an unselected, female, Dutch reference population. A longitudinal linear mixed model was applied to assess changes in QOL over time after LH and to determine if in patients ≥65 years of age QOL scores were different.ResultsData on 116 patients were available for analysis. The median age was 54 years at time of surgery (range 34–83) with an interquartile range of 43–65 years. Six months after LH, all QOL values were higher than before surgery and were equal to or higher than those of the reference population. Older women tend to score higher on QOL preoperatively, and these scores remain high postoperatively.ConclusionAfter LH, QOL improves. Older women report higher QOL values preoperatively and QOL is still high 6 months after the operation. Age does not confer a negative impact on QOL following LH and should not be the reason to refrain from laparoscopic surgery.

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“…Moreover, obesity rates have escalated rapidly during the last decade while a steady increase of the disease is predicted, at least until 2030. Obese patients represent a particular patient population and thus require special management (4). Additionally, a significant correlation among obesity and development of various types of malignancies such as pancreatic, liver, breast and EC has been described (5).…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of synchronous panniculectomy and endometrial cancer surgery in obese patients: a systematic review of the literature and meta-analysis of postoperative complications

Prodromidou

Iavazzo

Psomiadou

et al. 2020

J Turkish German Gynecol Assoc

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Panniculectomy combined gynaecological surgery constitutes an alternative approach for endometrial cancer (EC) in obese patients. The present study aimed to accumulate the current knowledge on the safety and efficacy of combining panniculectomy in surgical management of EC. A total of 4 electronic databases were systematically searched for articles published up to May 2019. A total of 5 studies (2 non-comparative and 3 comparative) were included. Meta-analysis of complications among panniculectomy and conventional laparotomy group revealed no difference in complication rates (intraoperative or postoperative). Moreover, no difference was reported in surgical site complications (p=0.59), while wound breakdown rates were found significantly elevated in laparotomy group (p=0.02). Panniculectomy combined surgery for the management of EC is a safe procedure and presents comparable outcomes to those of conventional laparotomy with regards to complications and improved wound breakdown rates.

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Defining and mitigating the challenges of an older and obese population in minimally invasive gynecologic cancer surgery

Cited by 11 publications

References 73 publications

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Age should not be a limiting factor in laparoscopic surgery: a prospective multicenter cohort study on quality of life after laparoscopic hysterectomy

Safety and efficacy of synchronous panniculectomy and endometrial cancer surgery in obese patients: a systematic review of the literature and meta-analysis of postoperative complications

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