Hysterectomy for cervical cancer feasible in obese women

Obesity alone should not be a barrier to complete or “radical” hysterectomy for cervical cancer, according to a study reported in the journal of Obstetrics and Gynecology.

“Obese women are often considered poor candidates for radical surgery,” the authors explain. Many surgeons believe obese women have greater rates of blood loss and post-operative complications.

However, aside from greater estimated blood loss during surgery, the surgeons report that obese women had surgical, postoperative and recurrence outcomes that were comparable to their normal-weight peers.

Base on the study findings, radical hysterectomy with lymph node removal can be a definitive treatment for early-stage cervical cancer in women who are morbidly obese and have no other significant conditions, lead author Dr. Michael Frumovitz, from the M. D. Anderson Cancer Center in Houston, and colleagues conclude.

The findings are based on a review of 408 women who underwent radical hysterectomy for cervical cancer at Frumovitz’s center from 1990 to 2006.

Based on standard body mass index criteria, 155 (38 percent) women were normal weight, 126 (31 percent) were overweight, 77 (19 percent) were obese, and 50 (12 percent) were morbidly obese, the authors note.

No significant differences in age, other illness, smoking status, cancer stage, grade, tumor size, or depth of invasion were noted among the groups. Likewise, no weight-based differences in operative time or complications were seen.

The average estimated blood loss increased with weight, ranging from 500 milliliters for normal-weight women to 850 milliliters for the heaviest women, a difference that was statistically significant. This difference, however, did not appear to affect the outcome of surgery; the groups were comparable in terms of length of hospital stay, complications, and readmission rates.

Women in the different weight groups also had similar pathologic findings and rates of cervical cancer-related death over an average follow-up period of 64 months.

These results indicate that radical hysterectomy with pelvic lymph node removal is feasible in overweight, obese, and even morbidly obese women with early-stage cervical cancer and these women have outcomes that are just as good as their normal-weight counterparts, the authors conclude.

SOURCE: Obstetrics and Gynecology, October 2008.

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