Radical hysterectomy for cervical cancer in obese women

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).