Simple radiologic assessment of visceral obesity and prediction of
surgical morbidity in high-risk endometrial cancer: a reliability and
accuracy pilot study
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.