The effect of body mass index on surgical outcomes and survival following pelvic exenteration

David A. Iglesias, Shannon N. Westin, Vijayashri Rallapalli, Marilyn Huang, Bryan Fellman, Diana Urbauer, Michael Frumovitz, Pedro T. Ramirez, Pamela T. Soliman

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11 Scopus citations

Abstract

Objective: We sought to evaluate whether preoperative body mass index (BMI) impacts surgical outcomes, complication rates, and/or recurrence rates in women undergoing pelvic exenteration. Methods: All women who underwent pelvic exenteration for gynecologic indications at our institution from 1993 through 2010 were included. Women were stratified into 3 groups based on BMI. Baseline characteristics, surgical outcomes, early (< 60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were collected. Multivariate logistic regression analyses were performed. Kaplan-Meier survival curves were compared using log-rank test. Results: 161 patients were included (59 normal weight, 44 overweight, 58 obese). Median follow-up times were 22, 29, and 25 months. Most patients underwent total pelvic exenteration (68%); 64.6% had a vaginal reconstruction. On multivariate analysis, both overweight and obese patients had a higher risk of early superficial wound separation compared to normal weight patients - OR 10.74 (3.33-34.62, p < 0.001) and OR 4.35 (1.40-13.52, p = 0.011), respectively. Length of surgery was significantly longer for overweight (9.6 h, OR 1.26, 1.02-1.55, p = 0.032) and obese (10.1 h, OR 1.24, 1.04-1.47, p = 0.014) patients than for normal weight patients (8.7 h). Late postoperative complications for patients in the normal weight, overweight, and obese groups were 47.5%, 45.5%, and 43.1% (p = 0.144). There were no differences in time to recurrence (p = 0.752) or overall survival (p = 0.103) between groups. Conclusion: Although operative times were longer and risk for superficial wound separation was significantly higher, pelvic exenteration appears to be feasible and safe in overweight and obese women with overall complication rates and survival outcomes comparable to normal weight women.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalGynecologic oncology
Volume125
Issue number2
DOIs
StatePublished - May 1 2012

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Keywords

  • Cervical cancer
  • Complications
  • Obesity
  • Pelvic exenteration
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Iglesias, D. A., Westin, S. N., Rallapalli, V., Huang, M., Fellman, B., Urbauer, D., Frumovitz, M., Ramirez, P. T., & Soliman, P. T. (2012). The effect of body mass index on surgical outcomes and survival following pelvic exenteration. Gynecologic oncology, 125(2), 336-342. https://doi.org/10.1016/j.ygyno.2012.01.010