Gynecologic oncology · 2026
The feasibility of a medically supervised preoperative weight loss program in patients with obesity and atypical hyperplasia, or low-grade endometrial carcinoma.
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Aubrey Christa, Svajger Bruno, Batara Jesse, Chapelsky Sarah, Tromburg Courtney, Richard Logan, Pin Sophia
Аннотация
OBJECTIVES: To assess the efficacy of preoperative weight loss in women with obesity and either atypical hyperplasia (AEH), or low grade endometrial carcinoma (EC), measured through weight change.
METHODS: Prospective cohort study in women with AEH or EC, and a BMI of ≥ 40 kg/m2. Preoperative weight loss was medically supervised, utilizing Optifast 900® full meal replacement for 12 weeks, or a hybrid approach. Follow up was 12 months after surgery. Demographic, laboratory, pathologic, clinical, and follow up outcomes were collected. Continuous variables were summarized as mean (SD) or median [IQR] based on normality (Shapiro-Wilk test); categorical variables as frequencies and percentages. Changes in weight and BMI were analyzed using paired t-tests or Wilcoxon Signed-Rank tests accordingly. Secondary analyses were exploratory. Patient experience was explored utilizing qualitative interviews and analyzed with thematic analysis until saturation.
RESULT: 104 patients enrolled from November 2020 to January 2022. Mean age 56 (SD 10.9), and BMI 50.0 kg/m2 (SD 7.9). 72/104 (69.2%) completed the intervention, and mean weight difference from consultation to surgery was -15.0 kg (SD 10.2, p < 0.01). Final pathology (FIGO 2009): 68/72 AEH or stage I EC, 3 stage II, 1 stage IIIC1. Mean weight difference from surgery to 8 weeks was -0.7 kg (SD 6.5, p 0.4280), and from surgery to 12 months was +3.53 kg (SD 10.5, p = 0.215). There was 1 recurrence that led to death at 2 years (stage IA, grade 1 EC, MMRd).
CONCLUSION: Preoperative weight loss appeared feasible and was associated with substantial short-term weight loss in selected patients with obesity and low risk endometrial cancer or AEH. Larger comparative studies are needed to determine perioperative benefit and oncologic safety.
METHODS: Prospective cohort study in women with AEH or EC, and a BMI of ≥ 40 kg/m2. Preoperative weight loss was medically supervised, utilizing Optifast 900® full meal replacement for 12 weeks, or a hybrid approach. Follow up was 12 months after surgery. Demographic, laboratory, pathologic, clinical, and follow up outcomes were collected. Continuous variables were summarized as mean (SD) or median [IQR] based on normality (Shapiro-Wilk test); categorical variables as frequencies and percentages. Changes in weight and BMI were analyzed using paired t-tests or Wilcoxon Signed-Rank tests accordingly. Secondary analyses were exploratory. Patient experience was explored utilizing qualitative interviews and analyzed with thematic analysis until saturation.
RESULT: 104 patients enrolled from November 2020 to January 2022. Mean age 56 (SD 10.9), and BMI 50.0 kg/m2 (SD 7.9). 72/104 (69.2%) completed the intervention, and mean weight difference from consultation to surgery was -15.0 kg (SD 10.2, p < 0.01). Final pathology (FIGO 2009): 68/72 AEH or stage I EC, 3 stage II, 1 stage IIIC1. Mean weight difference from surgery to 8 weeks was -0.7 kg (SD 6.5, p 0.4280), and from surgery to 12 months was +3.53 kg (SD 10.5, p = 0.215). There was 1 recurrence that led to death at 2 years (stage IA, grade 1 EC, MMRd).
CONCLUSION: Preoperative weight loss appeared feasible and was associated with substantial short-term weight loss in selected patients with obesity and low risk endometrial cancer or AEH. Larger comparative studies are needed to determine perioperative benefit and oncologic safety.