Int J Gynecol Cancer. 2025 Nov 26;36(1):102828. doi: 10.1016/j.ijgc.2025.102828. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to determine if the waist-to-hip ratio, an emerging indicator of abdominal obesity, predicts poor outcomes, such as sentinel node mapping failure, post-operative complications, conversion to laparotomy, and increased operative time, in endometrial cancer surgery.
METHODS: This retrospective study included patients with apparent early-stage endometrial carcinoma who underwent minimally invasive surgery at the Mauriziano Umberto I Hospital in Turin, Italy from January 2021 to January 2025. The waist-to-hip ratio was calculated using pre-operative computed tomography scans with previously described methods. Two cohorts based on a waist-to-hip ratio cutoff of 0.85, as defined by the World Health Organization, were identified and compared with statistical tests as appropriate. Univariate and multi-variable linear regression models were fit to evaluate predictors of poor surgical outcomes.
RESULTS: A total of 151 patients were included in the study. Abdominal obesity, as defined by an abnormal waist-to-hip ratio, was identified in 127 patients (84%), of whom 62 also had obesity according to the body mass index. Patients with abnormal waist-to-hip ratios were significantly older (median: 69 vs 61 years; p = .03), had higher body mass index (median: 29 vs 21 kg/m2; p < .001), and had higher comorbidity rates (67.7% vs 33.3%; p < .001) than patients with normal ratios. Their surgical procedures were significantly longer (median: 196 vs 174 minutes; p = .01), although no differences in sentinel node mapping or post-operative complication rates were found. After adjusting for potential confounders including body mass index, an abnormal waist-to-hip ratio remained significantly associated with increased operative time, corresponding to an average increase of 22 minutes (adjusted β coefficient: 22; 95% confidence interval; 2.3-42; p = .03).
CONCLUSIONS: An abnormal waist-to-hip ratio was significantly associated with increased operative time during minimally invasive surgery for endometrial cancer, whereas body mass index was not. Further research is needed to determine the predictive potential of the waist-to-hip ratio for personalized surgical planning.
PMID:41494215 | DOI:10.1016/j.ijgc.2025.102828
