The impact of body mass index on surgical outcomes of total laparoscopic radical hysterectomy in women with early-stage cervical cancer

Purpose: We sought to review our experience with total laparoscopic radical hysterectomy (TLRH), comparing surgical outcomes in women with ideal, overweight, and obese body mass indices (BMI). Materials and methods: We reviewed records from all TLRHs performed at our institution between 6/2012 and 2/2016. Comparison among groups was performed using single factor Analysis of Variance (ANOVA) or Fisher’s Exact Test, with P values < 0.05 considered statistically significant. Results: Thirty-seven patients underwent TLRH. Of these, 35 were treated for early-stage cervical cancer (stage IA = 6; IB = 29), 1 for clinical stage II uterine cancer, and 1 for suspected adenoma malignum. The median cervical tumor diameter was 2.0 cm (range 0-6 cm). Five patients had cancer-positive lymph nodes. The mean BMI was 29.2 (range 20.5-39.7). Specifically, 7 patients (19%) had an ideal body weight (BMI less than 25), 17 patients (46%) were overweight (BMI between 25 and 30), and 13 women (35%) were obese (BMI greater than 30). The mean operating room time was not significantly different among the three groups (P = 0.29). Similarly, the estimated blood loss among the three groups (146 mL vs 140 mL vs 140 mL; P = 0.98) did not differ. The mean number of lymph nodes removed was 22.9 in women with ideal body weight, 19 in overweight women, and 21.2 in obese women (P = 0.61). The mean duration of bladder catheterization was 14.1 days, with no difference among the three groups. There was a significant difference in length of post-operative hospitalization (P = .02) with a longer length of stay in the patients with BMI between 25 and 30 (1.8 days) vs BMI < 25 (1.3 days) and BMI > 30 (1.2 days). There were no significant intraoperative complications and no significant differences in postoperative complications among groups. Conclusions: TLRH in overweight and obese women did not confer increased operative or postoperative morbidity relative to women with normal BMI. TLRH should be considered in overweight and obese patients requiring radical hysterectomy.