INTRODUCTION
Current guidelines recommend that patients with high-risk endometrial
cancer undergo comprehensive surgical staging including the evaluation
of aortic nodes 1,2. But surgical staging is still
controversial 3. Minimally invasive surgery has long
ago proved its well-known benefits, and more recent techniques have
enhanced the options available. Laparoscopic para-aortic lymphadenectomy
can be performed in four different ways using conventional or
robotic-assisted laparoscopy, and the transperitoneal or extraperitoneal
approach. The procedure is generally safe, but each technique and
approach has its advantages and disadvantages. Although solid evidence
is lacking, it appears that the extraperitoneal technique and robotic
assistance are associated with less surgical morbidity4,5. But aortic evaluation is not without risks:
morbidity rates can rise beyond 50% 6.
The prediction of surgical morbidity is fundamental in gynaecological
oncology 6–10. One of the key factors associated with
surgical morbidity is obesity 11–13. Patients with
endometrial cancer are usually overweight, and a lot of them have
abdominal or visceral obesity, defined as an excess of intra-abdominal
fat 14. Some studies have shown a direct association
between visceral obesity and surgical morbidity15–18. But only one was conducted in endometrial
cancer patients 19.
Intra-abdominal fat can be evaluated by many anthropometric measurements
(e.g. waist circumference, waist-hip ratio, visceral fat area, and
sagittal abdominal diameter). Sagittal abdominal diameter (SAD) has been
demonstrated to be the best surrogate of intra-abdominal fat20. It can be measured using the Holtain Kahn
callipers in the office, but this can be a difficult task on obese
patients. SAD and intra-abdominal fat can also be measured by several
imaging methods (dual-energy X-ray absorptiometry, magnetic resonance
[MRI], and computed tomography [CT]), but its measurement has
not been standardized 21.
The current tools available to preoperatively assess surgical morbidity
are limited. We lack a “one-size-fits-all” measurement since surgical
outcomes depend on the technique, the approach, and each specific
procedure. Moreover, the evaluation of obesity in gynaecological
oncology is scarce, and most studies focus only on body mass index
(BMI)—a widespread but limited measurement 22.
We asked whether the measurement of SAD in MRI is reliable and useful to
predict surgical morbidity in high-risk endometrial cancer patients
undergoing minimally invasive aortic lymphadenectomy. This is the first
study to evaluate this measurement as a method to predict surgical
morbidity in endometrial cancer patients.