The surgical management of morbidly obese women with endometrial cancer

Stephanie Kuku, John Dick, Adeola Olaitan

Department of Gynaecologic Oncology, University College London Hospitals, London.
Department of Gynaecologic Oncology, University College London Hospitals, London, UK.
University College London Hospitals, London.

DOI: 10.4236/health.2012.412A208                

Abstract

There is an obesity epidemic in the Western World. Currently one in four adults is obese and three in ten children in the UK is overweight or obese [1]. The UK Foresight Study [2] predicts that if nothing is done, this figure will rise to five in ten (50%) in women by 2050. The endocrine changes induced by obesity lead to an increased incidence of endometrial cancer. The majority of women with endometrial cancer present with early disease which means that surgery will form all or part of their treatment. This presents serious challenges as these women often have associated comorbid conditions. In this article we explore the relationship between obesity and endometrial cancer and highlight the surgical challenges.

Keywords

Obesity; Endometrial Cancer; Laparoscopic Surgery; Vaginal Surgery; Robotic Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Office for National Statistics (2010) England.
[2]	Foresight Project (2007) Tackling obesities: Future choices Foresight Project. http://foresight.gov.uk
[3]	Branca, F., Nigogosian, H. and Lobstein, T. (2007) The challenge of obesity in the WHO European Region and the strategies for the response. WHO, Co-penhagen.
[4]	World Health Organization (2011) Obesity and overweight. http://who.int/mediacentre/factsheet/fs311/en/
[5]	Sturm, R. (2007) Increases in morbid obesity in the USA: 2000-2005. Public Health, 121, 492-496. doi:10.1016/j.puhe.2007.01.006
[6]	Parazzini, F., LaVecchia, C., Bocciolone, L., et al. (1991) The epidemiology of endome-trial cancer. Gynecologic Oncology, 41, 1-16. doi:10.1016/0090-8258(91)90246-2
[7]	Calle, E.E., Rodri-guez, C., Walker-Thurmond, K. and Thun, M.J. (2003) Over-weight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. The New England Journal of Medicine, 348, 1625-1638. doi:10.1056/NEJMoa021423
[8]	Cancer Research UK Statistics (2008) Cancer statistics registrations: Registrations of can-cers diagnosed in 2008. www.cancerresearchuk.ork
[9]	Schouten, L.J., Goldbohm, R.A. and van den Brandt, P.A. (2004) Anthropometry, physical activity, and endometrial cancer risk: Results from the Nether-lands Cohort Study. Journal of the National Cancer Institute, 96, 1635-1638. doi:10.1093/jnci/djh291
[10]	Bokhman, J.V. (1983) Two pa-thogenic types of endome- trial carcinoma. Gynecologic On-cology, 15, 10-17. doi:10.1016/0090-8258(83)90111-7
[11]	Corocleanu, M. (1993) Hypothesis for endometrial carcinoma carcinogenesis. Preventive prospects. Clinical & Experimental Obstetrics & Gynecology, 20, 254-258.
[12]	Von Gruenigen, V.E., Gil, K.M., Frasure, H.E., Jenison, E.J. and Hopkins, M.P. (2005) The impact of obesity and ago on quality of life in gynecologic surgery. American Journal of Obstetrics & Gynecology, 193, 1369-1375. doi:10.1016/j.ajog.2005.03.038
[13]	Kitchener, H., Swart, A.M., Qian, Q., Amos, C., Parmar, M.K. (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC): A randomized study. Lancet, 373, 125-136. doi:10.1016/S0140-6736(08)61766-3
[14]	De la Orden, S.G., Reza, M., Blasco, J.A., Andradas, E., Callejo, D. and Perez, T. (2008) Laparoscopic hysterictomy in the treatment of endo-metrial cancer: A systematic review. Journal of Minimally In-vasive Gynecology, 15, 395-401. doi:10.1016/j.jmig.2008.04.018
[15]	Palomba, S., Falbo, A., Mocciaro, R., Russo, T. and Zullo, F. (2009) Laparoscopic treatment for endometrial cancer: A meta-analysis of randomized controlled trials (RCTs). Gynecologic Oncology, 112, 415-421. doi:10.1016/j.ygyno.2008.09.014
[16]	Palomba, S., Falbo, A., Russo, T. and Zullo, F. (2009) Updating a recent meta-analysis of randomized controlled trials to assess safety and efficacy of laparoscopic surgery for treating early stage endometrial cancer. Gynecologic Oncology, 114, 135-136. doi:10.1016/j.ygyno.2009.03.025
[17]	Tozzi, R., Malur, S., Koehler, C., et al. (2005) Laparoscopy versus laparotomy in endometrial cancer: First ana- lysis of survival of a randomized prospective study. JMIG, 12, 130-36.
[18]	Palomba, S., Ghezzi, F., Falbo, A., et al. (2012) Laparoscopic versus ab-dominal approach to endometrial cancer; a 10 year retrospective multicenter analysis. International Journal of Gynecological Cancer, 22, 425-433.
[19]	Zullo, F., Falbo, A. and Palomba, S. (2012) Safety of la- paroscopy versus laparotomy in the surgical staging of endometrial cancer; a systematic review and meta-analysis of randomized controlled trials. American Journal of Obstetrics & Gynecology, 207, 94-100. doi:10.1016/j.ajog.2012.01.010
[20]	Mourtis, M., Bijien, C.B., Arts, H.J., ter Brugge, H., et al. (2010) Safety of laparoscopy versus laparotomy in early- stage endometrial cancer: a rando-mized trial. The Lancet Oncology, 11, 763-771. doi:10.1016/S1470-2045(10)70143-1
[21]	Janda, M., Gebski, V., Brand, A., et al. (2010) Quality of life after total laparoscopic hysterectomy versus total ab- dominal hysterectomy for stage I endometrial cancer (LA- CE): A randomized trial. The Lancet Oncology, 11, 772- 780. doi:10.1016/S1470-2045(10)70145-5
[22]	Walker, J.L., Pied-monte, M.R., Spirtos, N.M., et al. (2009) Laparoscopy compared with laparotomy for comprehendsive surgical staging of uterine cancer: Gynecologic on- cology group study LAP2. Journal of Clinical Oncology, 27, 5331-5336. doi:10.1200/JCO.2009.22.3248
[23]	Abu-Abid, S., Szold, A. and Klausner, J. (2002) Obesity and cancer. Journal of Medicine, 33, 73-86.
[24]	Palomba, S., Zupi, E., Russo, T., et al. (2007) Presurgical assessment of intraabdominal visceral fat in obese pa- tients with early-stage endometrial cancer treated with laparoscopic approach: Relationships with early laparoscopic conversions. Journal of Minimally Invasive Gynecology, 14, 195-201. doi:10.1016/j.jmig.2006.09.019
[25]	Holub, Z., Jabor, A., Sprongl, L. and Fischlova, D. (2002) Clinical outcome, in-flammatory response and tissue trau- ma in total laparoscopic hysterectomy: Comparison to la- paroscopically-assisted vaginal hysterectomy. Ces Gyne- kol, 67, 315-20.
[26]	Farthing, A., Chatterjee, J., Joglekar-Pai, P., Dorney, E. and Ghaem-Maghami, S. (2012) Total laparoscopic hys- terectomy for early stage endometrial cancer in obese and morbidly obese women. Journal of Obstetrics & Gynaecology, 32, 580-584. doi:10.3109/01443615.2012.693990
[27]	O’Hanlan, K.A., Dibble, S.L. and Fisher, D.T. (2006) Total laparoscopic hyste-rectomy for uterine pathology: Impact of body mass index on outcomes. Gynecologic Oncology, 103, 938-941. doi:10.1016/j.ygyno.2006.05.036
[28]	Yu, C.K., Cutner, A., Mould, T. and Olaitan, A. (2005) Total laparoscopic hyste-rectomy as a primary surgical treatment for endometrial cancer in morbidly obese wo- men. BJOG, 112, 115-117. doi:10.1111/j.1471-0528.2004.00335.x
[29]	Scribner Jr, D.R., Walker, J.L., Johnson, G.A., et al. (2002) Laparoscopic pelvic and para-aotic lymph node dissection in the Obese. Gynecologic Oncology, 84, 426-430. doi:10.1006/gyno.2001.6548
[30]	Pavelka, J.C., Ben-Shachar, I., Fowler, J.M., et al. (2004) Morbid obesity and endometrial cancer: Surgical, clinical, and pathologic outcomes in surgically managed patients. Gynecologic Oncology, 95, 588-592. doi:10.1016/j.ygyno.2004.07.047
[31]	Obermair, A., Manolit-sas, T.P., Yeung, Y., Hammond, I.G. and McCartney, A.J. (2005) Total laparoscopic hysteric- tomy versus total abdominal hys-terectomy for obese wo- men with endometrial cancer. Interna-tional Journal of Gynecological Cancer, 15, 319-324. doi:10.1111/j.1525-1438.2005.15223.x
[32]	Dumont, L., Mat-tys, M., Mardirosoff, C., Picard, V., Alle, J.L., et al. (1997) Hemodynamic and pulmonary changes during laparoscopic gastroplasty in morbidly obese pa- tients. Obesity Surgery, 7, 326-331.
[33]	O’Gorman, T., MacDonald, N., Mould, T., Cutner, A., Hurley, R. and Olaitan, A. (2009) Total laparoscopic hys- terectomy in morbidly obese women with endometrial cancer anaesthetic and surgical considerations. European Journal of Gynaecological Oncology, 30, 171-173
[34]	Bloss, J.D., Berman, M.L., Bloss, L.P. and Buller, R.E. (1991) Use of vaginal hysterectomy for the man-agement of stage 1 endometrial cancer in the medically compro- mised patient. Gynecologic Oncology, 40, 74-77. doi:10.1016/0090-8258(91)90089-N
[35]	Childers, J.M. and Surwit, E.A. (1992) Combined laparo- scopic and vaginal sur-gery for the managemement of two cases of stage I endometrial cancer. Gynecologic Oncol- ogy, 45, 46-51. doi:10.1016/0090-8258(92)90489-6
[36]	Doucette, R.C. and Scott, J.R. (1996) Comparison of la- paroscopically assisted vaginal hysterectomy with abdo- minal and vaginal hysterectomy. Journal of Reproductive Medicine, 41, 1-6.
[37]	Sheth, S.S. (2010) Vaginal hysterectomy as a primary route for morbidly obese women. Acta Obstetricia et Gynecologica Scandinavica, 89, 971-974. doi:10.3109/00016341003681256
[38]	Guigale, L.E., Di Santo, N., Smolkin, M.E., Havrilesky, L.J. and Modesitt, S.C. (2012) Beyond mere obesity: Effect of increasing obesity classifica-tions on hysterectomy outcomes for uterine cancer/hyperplasia. Gynecologic Oncology, 127, 326-331. doi:10.1016/j.ygyno.2012.08.014
[39]	Gehrig, P.A., Cantrell, L.A., Shafer, A., et al. (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecologic Oncology, 111, 41-45. doi:10.1016/j.ygyno.2008.06.030
[40]	Tang, K.Y., Gardiner, S.K., Gould, C., et al. (2012) Ro- botic surgical staging for obese women with endometrial cancer. American Journal of Obstetrics & Gynecology, 206, e1-e6.
[41]	Seamon, L.G., Bryant, S.A., Rheaume, P.S., et al. (2009) Comprehensive sur-gical staging for endometrial cancer in obese patients: comparing robotics and laparotomy. Obstetrics & Gynecology, 114, 16-21.
[42]	Subramaniam, A., Kim, K.H., Bryant, S.A., Zhang, B., et al. (2011) A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial cancer. Gynecologic Oncology, 122, 604-607. doi:10.1016/j.ygyno.2011.05.024