Objective: To estimate the morbidity, adequacy of surgery, and survival of
obese women undergoing radical hysterectomy and pelvic lymphadenectomy.
Methods: Patients with stage I and IIa cervical cancer and a body mass inde
x (BMI) over 30 kg/m(2) and absolute weight greater than 85 kg explored wit
h the intent for radical hysterectomy between 1986 and 1998 were identified
. Patient characteristics, surgical, pathologic, and follow-up data were ex
tracted and survival curves were generated.
Results: Forty-eight obese women were identified who were explored for radi
cal hysterectomy and pelvic lymph node dissection. The median BMI was 36 kg
/m2, and the median weight was 95 kg. Thirty-five patients (73%) had stage
Ib1 disease. Despite the obesity of the study group, none had severe comorb
idity. The procedure was completed in 46 patients, and abandoned in two bec
ause of metastatic disease. For patients undergoing radical hysterectomy an
d pelvic lymph node dissection, median blood loss was 800 mL. No patient de
veloped fistulas. Residual tumor was present in 26 (57%) hysterectomy speci
mens, and margins were without disease in 45 specimens (98%). A median of 2
6 pelvic lymph nodes were obtained per procedure, and six patients (13%) ha
d positive nodes. Five-year overall and disease-free survival are 84% (95%
confidence interval [CI] 70.9, 97.5) and 80% (95% CI 65.2, 93.8), respectiv
ely, at a median follow-up of 36 months.
Conclusion: In this carefully selected obese group, we demonstrate that rad
ical hysterectomy and pelvic lymph node dissection can be performed with ad
equate surgical resection, acceptable morbidity, and excellent survival. (O
bstet Gynecol 2000;96:727-31. (C) 2000 by The American College of Obstetric
ians and Gynecologists).