Identifying risk factors for postoperative complications following staging surgery for endometrial cancer

Abstract

Introduction

Endometrial cancer is the most prevalent gynecologic malignancy, with increasing incidence primarily due to aging, obesity, and diabetes. Surgical staging, a gold standard treatment involving total hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsy, presents various postoperative complications influencing patient outcomes and healthcare costs. This study aims to identify risk factors associated with short term postoperative complications following staging surgery for endometrial cancer.

Methods

A retrospective cohort study conducted at a single university-affiliated medical center from January 2016 to December 2022. Data were extracted from electronic medical records, including patient demographics and comorbidities, surgical data including intraoperative complications, tumor histology and surgical outcomes. A composite adverse post operative outcome was defined, including need for post-operative blood transfusion, antibiotic treatment, Intensive care unit (ICU) admission, prolonged hospitalization, and 30-day readmission rates.

Results

Among 495 patients, 34.3 % experienced at least one postoperative complication. Significant factors associated with complications included age over 65, ASA score >2, pathologic grade 3 tumours, and non-minimally invasive surgical approaches. Prolonged operative time (>75th percentile) and intraoperative complications also correlated with increased risk. Conversely, higher preoperative haemoglobin levels were protective against complications.

Conclusion

The findings emphasize the importance of recognizing risk factors such as advanced age, elevated ASA scores, and specific tumor characteristics to enhance preoperative assessments and surgical planning. By tailoring surgical approaches and optimizing patient preparation, healthcare providers may improve postoperative outcomes and reduce complications for patients undergoing staging surgery for endometrial cancer.