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Simple radiologic assessment of visceral obesity and prediction of surgical morbidity in high-risk endometrial cancer: a reliability and accuracy pilot study
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  • Alejandro Correa-Paris,
  • Verónica Gorraiz Ochoa,
  • Alicia Hernández,
  • Juan Gilabert-Estelles,
  • Berta Díaz-Feijoo,
  • Antonio Gil-Moreno
Alejandro Correa-Paris
Health Independent Research United (HIRU)
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Verónica Gorraiz Ochoa
Health Independent Research United (HIRU)
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Alicia Hernández
Hospital Universitario La Paz
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Juan Gilabert-Estelles
Consorci Hospital General Universitari de Valencia
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Berta Díaz-Feijoo
Hospital Vall d'Hebron
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Antonio Gil-Moreno
Hospital Vall d'Hebron
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Abstract

Objective: To evaluate the reliability of sagittal abdominal diameter (SAD)—a surrogate of visceral obesity—in MRI, and its accuracy to predict the surgical morbidity of aortic lymphadenectomy. Design: A multicentre reliability (phase 1) and accuracy (phase 2) cohort study. Setting: Three Spanish referral hospitals. Population: High-risk endometrial cancer patients undergoing minimally invasive surgical staging. Patients were classified into subgroups: conventional vs. robotic-assisted laparoscopy, and transperitoneal vs. extraperitoneal technique. Methods: Retrospective analysis of data from the STELLA-2 randomized controlled trial. In the first phase, we measured the agreement of three SAD measurements (at the umbilicus, the renal vein, and the inferior mesenteric artery) and selected the most reliable one. In phase two, we evaluated the diagnostic accuracy of SAD to predict surgical morbidity. Main Outcome Measures: surgical morbidity was defined by a core outcome set including variables related to blood loss, operative time, surgical complications, and para-aortic lymphadenectomy difficulty. Results: In phase one, all measurements showed good inter-rater and intra-rater agreement. Umbilical SAD was the most reliable one. In phase two, we included 136 patients. Umbilical SAD had a good diagnostic accuracy to predict surgical morbidity in patients undergoing transperitoneal laparoscopic lymphadenectomy (0.73 in ROC curve). It performed better than BMI and other anthropometric measurements. We calculated a cut-off point of 246 mm (sensitivity: 0.56 and specificity: 0.80). Conclusions: Umbilical SAD is a simple, reliable, and potentially useful measurement to predict surgical morbidity in endometrial cancer patients undergoing minimally invasive surgical staging, especially when facing transperitoneal aortic lymphadenectomy.

Peer review status:UNDER REVIEW

24 Mar 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
26 Mar 2021Assigned to Editor
26 Mar 2021Submission Checks Completed
06 Apr 2021Reviewer(s) Assigned